Pre-op oral antibiotics prior to elective colorectal surgery

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Post-operative surgical site infection (SSI) after colorectal surgery causes significant morbidity and mortality. Due to concerns over such infections, the NHS Highland Colorectal SSI Quality Improvement Group was formed in late 2011. Infection control surveillance of post-operative infections showed variation in practice in a number of areas including skin closure, on time antibiotic prophylaxis, peri-operative temperature and blood glucose levels and post-operative wound dressing management.  Since the constitution of the group and the standardisation of pre, peri and post-operative management, the SSI rate has reduced by one third.  In 2016, the World Health Organisation published guidelines to reduce SSI after surgery.  The document contains 9 strong and 21 conditional recommendations specific to colorectal surgery.  NHS Highland Colorectal SSI Quality Improvement Group has considered each of the recommendations within the guidelines in turn with the majority being adopted or already in place.  Antibiotic use around the time of surgery is restricted to intravenous prophylaxis given in the 60 minutes prior to skin incision for a single dose unless the procedure last more than four hours or there is blood loss above 1500mL, in line with WHO, NICE Guidelines 125 and SIGN Guidelines 104.

Note.  In April 2021, neomycin 500mg tablets were discontinued in the UK.  A source of unlicensed tablets has been obtained and this information has been added to the prescription form to highlight to the prescriber.

For glossary of terms see Glossary

Protocol: Use of oral antibiotics prior to colorectal surgery

On the day before surgery, the patient will be prescribed oral neomycin 1g and metronidazole 400mg to be taken at 3pm, 4pm and 10pm.  This will be dispensed for the patient in advance of attending for surgery.  The medication will be collected on the day before surgery when attending the ward for administration of DVT prophylaxis.  
N.B. All patients must receive bowel preparation with Vistaprep IN ADDITION TO pre-operative oral antibiotics.

To inform surgical site surveillance data collection, the consultant will record whether the patient took all prescribed doses of antibiotic in the medical notes.

 

Pre-op Colorectal Oral Antibiotic Prescription Form

This can be obtained here (intranet access required).

Last reviewed: 31 August 2021

Next review: 31 August 2023

Author(s): Antimicrobial Management Team

Version: 1.2

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Area Antimicrobial Pharmacist

Document Id: AMT118