Bowel Prep and Oral Antibiotics in Colorectal Surgery

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In the excellent article by Garfinkle et al,1 I am afraid that I have been misquoted in their discussion of the benefits and harms of mechanical bowel preparation. In the Cochrane review I authored, only the effects of antibiotics on surgical wound infection risk (surgical site infection (SSI)) were assessed.2 The review of mechanical bowel preparation by Güenaga et al3 was cited. In the latter review, it was clearly shown that bowel preparation had little effect on the risk of SSI. Because there appeared in my review to be a synergistic effect of oral and intravenous antibiotics in preventing SSI, and because, at least in Europe, mechanical bowel preparation has been largely eliminated in preparing patients for colon resection, I have suggested that it is time that a randomized trial was done to see whether mechanical cleansing was necessary for oral antibiotics to be effective. It is hardly intuitive, but much of what has been found in Cochrane reviews has been counterintuitive. The current article by Garfinkle et al1 certainly supports the need for such a trial.
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