Magazine article Drug Topics

Clinical Twisters: Reducing Risk of Infection

Magazine article Drug Topics

Clinical Twisters: Reducing Risk of Infection

Article excerpt

A 46-year-old male who has had ulcerative colitis for the past 20 years was admitted to your hospital for treatment of adenocarcinoma. Four years ago, when the patient developed a malignant polypoid lesion at the transverse colon, subtotal colectomy with ileorectal anastomosis was performed. The current lesion is at the level of the anastomosis. A proctectomy with construction of deal J-pouch and ileoanal anastomosis is planned. On admission, the patient is taking sulfasalazine. What recommendations (drug choice, timing, duration of treatment) do you make for prevention of postoperative infection?

Several factors play important roles in the selection of perioperative antimicrobial therapy and prevention of postoperative infections. Close attention should be paid to the patient's drug allergies, social history (alcohol use), medical history, pre-op labs, and type of surgery planned. A proctectomy with construction of ileal J-pouch and creation of an ileoanal anastomosis is considered a clean-contaminated case, and the patient has no allergies or significant medical history.

My recommendations include:

* Standard mechanical bowel preparation containing sodium phosphate solutions on the day prior to surgery, a clear liquid diet, and IV fluid to keep the patient hydrated. Use of these preparations in patients without an ileocecal valve requires close observation.

* Cefoxitin 2 gm should be given with the induction of anesthesia and continued every six hours for 24 hours.

The use of the Nichols-Condon oral neomycin-erythromycin base antibiotic combination with the mechanical bowel preparation would be of questionable additional benefit as this patient has little to no large intestine and the literature for its use is not as strong.

Anne M. Tucker, Pharm.D.

Clinical Pharmacy Specialist

University of Texas

M. …

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