Role of oral antibiotics for prophylaxis against surgical site infections after elective colorectal surgery

Table 1 Published meta-analyses evaluating the use of oral antibiotics for surgical site infection prophylaxis in elective colorectal surgery

Ref.	Summary	Surgical Site Infections in patients who received antibiotic prophylaxis via			Strength/weakness of study	Conclusion
		Combined oral + IV routes	IV route alone	Oral route alone
Lewis et al[5] (2002)	Meta-analysis of randomized trials comparing IV vs combined antibiotic prophylaxis in 2065 patients	68/988 (6.88%)	146/1077 (13.56%)	0	The major criticism was that they included studies that used absorbable and non-absorbable oral antibiotics.	Combination therapy significantly reduced overall SSI rates (RR = 0.51, 95%CI: 0.24-0.78; P < 0.001) vs IV antibiotics alone
Nelson et al[8] (2014 revision)	Metanalysis of 2929 patients across 15 randomized studies compared combined vs IV alone	100/1456 (6.87%)	188/1473 (12.76%)	0	All 13 trials were randomized controlled trials but only 5 were blinded studies Some included MBP Antibiotics not standardized Included absorbable oral antibiotics	Combination therapy significantly reduced SSI rates (RR = 0.55, 95%CI: 0.43 to 0.71; P = 0.0001) compared to IV alone
Nelson et al[8] (2014 revision)	Metanalysis of 1880 patients across 9 randomized studies comparing combined oral + IV antibiotics vs oral alone	39/943 (4.14%)	0	74/931 (7.95%)	7 studies used adequate randomization and 4 were blinded studies Many study variables Some included MBP Antibiotics not standardized	Combination therapy significantly reduced SSI rates (RR = 0.52, 95%CI: 0.35 to 0.76; P = 0.0003) vs oral alone
Bellows et al[1] (2011)	Metanalysis of 2669 patients across 16 randomized trials comparing combined oral + IV antibiotics vs IV antibiotics alone	91/1352 (6.73%)	159/1317 (12.07%)	0	Included absorbable oral antibiotics Only evaluated recent studies using non-absorbable oral antibiotics 7 were blinded studies 7 studies followed patients for hospital duration only	Combination therapy significantly reduced rates of superficial and deep SSI [RR = 0.57 (95%CI: 0.43–0.76), P = 0.0002; risk difference, -0.05 (95%CI: -0.08 to -0.02), P = 0.0003] vs IV alone No difference in organ space infections [RR = 0.71 (95%CI: 0.43–1.16), P = 0.2] or anastomotic leaks [RR = 0.63 (95%CI: 0.28–1.41), P = 0.3]

SSI: Surgical site infections; MBP: Mechanical bowel preparation.