Preventive systemic antibiotics in colorectal surgery.

BACKGROUND: Elective colon surgery has the highest rate of surgical site infection (SSI) of any elective procedure in surgery. The evolution of strategies for the prevention of SSI has had the correct use of preventive antibiotics as a crucial component. METHODS: Review of the pertinent English-language literature. RESULTS: Correct use of prophylactic antibiotics in elective colon surgery requires that the drug have activity against colonic aerobic and anaerobic bacteria, be administered immediately before the surgical incision, and not be continued into the postoperative period. All of the documented and many of the theoretically feasible antibiotic choices are discussed in terms of their advantages for this indication. CONCLUSIONS: The best outcomes in the prevention of SSI in elective colon surgery are achieved when appropriate systemic antibiotics are employed in conjunction with the appropriate use of oral antibiotic bowel preparation.