The Authors Reply

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Excerpt

On behalf of our coauthors, we thank Dr Nelson for his comments about our recently published study on the subject of bowel preparation before elective colorectal surgery.1 The concern that he raises in his Letter to the Editor is that we misquoted his Cochrane review evaluating the use of antibiotic prophylaxis in colorectal surgery.2 Although his review supports the benefit of preoperative oral and intravenous antibiotics in reducing surgical wound infections, it did not examine the use of mechanical bowel preparation. We appreciate Dr Nelson highlighting this important difference, because studies examining either component of preoperative preparation (antibiotics or mechanical preparation) were grouped together in the introduction of our article. Although there is a growing body of evidence that oral antibiotics are the key players in reducing postoperative infections, we agree that a randomized controlled trial featuring ≥3 arms (no preparation, oral antibiotics alone, and oral antibiotics and mechanical bowel preparation) would be ideal to demonstrate the independent effect of oral antibiotics in the absence of mechanically cleansing the colon. Unfortunately, this would be a very arduous undertaking, requiring a large number of patients, forcing surgeons in the meantime to rely on the vast array of literature already published on the subject to guide their clinical practice.
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