Title

Use of mechanical bowel preparation and oral antibiotics for elective colorectal procedures in children: is current practice evidence-based?

Document Type

Article

Publication Date

6-1-2014

Identifier

DOI: 10.1016/j.jpedsurg.2014.01.048

Abstract

PURPOSE: It is well established through randomized trials that oral antibiotics given with or without a mechanical bowel preparation (MBP) prior to colorectal procedures reduce complications, while MBP given alone provides no benefit. We aimed to characterize trends surrounding bowel preparation in children and determine whether contemporary practice is evidence-based.

METHODS: Retrospective analysis of patients undergoing colorectal procedures at 42 children's hospitals (1/2/2007-12/31/2011) was performed. Patients were analyzed for diagnosis, pre-admission status, and inpatient bowel preparation. Bowel preparation was considered evidence-based if oral antibiotics were utilized with or without a MBP.

RESULTS: 49% of all patients were pre-admitted (n=5,473), and the most common diagnoses were anorectal malformations (55%), inflammatory bowel disease (26%), and Hirschsprung's Disease (19%). The most common preparation approaches were MBP alone (54.3%), MBP+oral antibiotics (18.8%), and oral antibiotics alone (4.2%), although significant variation was found in hospital-specific rates for each approach (MBP alone: 0-96.1%, MBP+oral antibiotics: 0-83.6%, orals alone: 0-91.6%, p

CONCLUSION: According to the best available clinical evidence, less than a quarter of all children pre-admitted for elective colorectal procedures receive a bowel preparation proven to reduce infectious complications.

Journal Title

Journal of pediatric surgery

Volume

49

Issue

6

First Page

1030

Last Page

1035

MeSH Keywords

Administration, Oral; Adolescent; Anti-Bacterial Agents; Antibiotic Prophylaxis; Child; Child, Preschool; Colorectal Surgery; Elective Surgical Procedures; Enema; Evidence-Based Medicine; Female; Follow-Up Studies; Humans; Infant; Male; Preoperative Care; Retrospective Studies; Surgical Wound Infection

Keywords

Antibiotic prophylaxis; Mechanical bowel preparation; Non-absorbable oral antibiotics; colorectal surgery

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