Oral antibiotics and Mechanical Bowel Preparation

• The 2017 ESCP Cohort Study collected prospective data on 3676 patients who underwent left hemicolectomy across 343 centres in 47 countries.
• It demonstrated that oral antibiotics plus MBP was associated with lower risk of anastomotic leak vs only MBP after risk adjustment. However this included left sided colectomy only, and the applicability to right colectomy is uncertain.
• Related paper: Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection

• In a retrospective data, Ambe and colleagues demonstrated similar results and concluded that mechanical bowel preparation with additive non-absorbable oral antibiotics may be recommended prior to elective colorectal surgery.
• Related paper: Routine preoperative mechanical bowel preparation with additive oral antibiotics is associated with a reduced risk of anastomotic leakage in patients undergoing elective oncologic resection for colorectal cancer

• Data from the USA ACS-NSQIP, also demonstrated a potential benefit to combined oral antibiotics with MBP
• Related paper: Combined Preoperative Mechanical Bowel Preparation With Oral Antibiotics Significantly Reduces Surgical Site Infection, Anastomotic Leak, and Ileus After Colorectal Surgery

• Based on these studies, oral antibiotics and MBP are being considered in ERAS pathway guidelines
• Related paper: Preoperative Mechanical and Oral Antibiotic Bowel Preparation to Reduce Infectious Complications of Colorectal Surgery – The Need for Updated Guidelines

Randomised trials are ongoing to answer this important question.