Bowel Preparation for Elective Colorectal Procedures: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Three systematic reviews and five randomized controlled trials were identified describing the clinical effectiveness of antibiotic prophylaxis as part of bowel preparation for elective colorectal procedures. No evidence describing cost-effectiveness was identified and seven evidence-based guidelines were found to be eligible for this review. Most studies reporting on clinical effectiveness investigated surgical site infections in patients receiving combined
intravenous and oral antibiotic prophylaxis versus intravenous antibiotic prophylaxis only (most often with mechanical bowel preparation). Three systematic reviews of good quality and four randomized controlled trials of variable quality reported statistically significant improvements in surgical site infections for patients receiving combined intravenous and oral antibiotic prophylaxis as compared to patients receiving intravenous antibiotic
prophylaxis only. Whereas rates of incisional surgical site infections were generally found to also be reduced in patients receiving combined intravenous and oral antibiotic prophylaxis as compared to patients receiving intravenous antibiotic prophylaxis only, differences were not generally observed in organ/space infections. Across three studies reporting on adverse effects, there were few statistically differences observed between groups. Guidelines generally favoured the use of intravenous and oral antibiotics (either alone or combined), with some recommending the use of mechanical bowel preparation in combination with
intravenous and/or oral antibiotics, and others recommending that mechanical bowel preparation not be used at all. The authors of most included sources either concluded or recommended that combination oral and intravenous antibiotic prophylaxis be used for reducing surgical site infection in patients undergoing elective colorectal procedures.