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J R Soc Med. 1980 April; 73(4): 238–240.
PMCID: PMC1437403

Importance of adding neomycin to metronidazole for bowel preparation1


A prospective randomized trial has investigated whether it is necessary to add oral neomycin to oral metronidazole as a means of preventing sepsis in elective colonic resection. Seventy-three patients completed the study; 41 received metronidazole and placebo neomycin and 32 received metronidazole and active neomycin. There was a significant reduction in the incidence of wound infection in patients receiving neomycin and metronidazole (22%) compared with metronidazole alone (51%, P<0.02). There was also a significant reduction in anaerobic infections in the group receiving metronidazole and neomycin compared with metronidazole alone (P<0.05). These results indicate that oral metronidazole alone is of no benefit for patients requiring elective colonic operations and that if oral metronidazole is advised it should always be given in combination with oral neomycin.

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Selected References

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  • Arabi Y, Dimock F, Burdon DW, Alexander-Williams J, Keighley MR. Influence of bowel preparation and antimicrobials on colonic microflora. Br J Surg. 1978 Aug;65(8):555–558. [PubMed]
  • Arabi Y, Dimock F, Burdon DW, Alexander-Williams J, Keighley MR. Influence of neomycin and metronidazole on colonic microflora of volunteers. J Antimicrob Chemother. 1979 Sep;5(5):531–537. [PubMed]
  • Clarke JS, Condon RE, Bartlett JG, Gorbach SL, Nichols RL, Ochi S. Preoperative oral antibiotics reduce septic complications of colon operations: results of prospective, randomized, double-blind clinical study. Ann Surg. 1977 Sep;186(3):251–259. [PubMed]
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  • Keighley MR, Crapp AR, Burdon DW, Cooke WT, Alexander-Williams J. Prophylaxis against anaerobic sepsis in bowel surgery. Br J Surg. 1976 Jul;63(7):538–541. [PubMed]
  • Leigh DA. Wound infections due to Bacteroides fragilis following intestinal surgery. Br J Surg. 1975 May;62(5):375–378. [PubMed]
  • Matheson DM, Arabi Y, Baxter-Smith D, Alexander-Williams J, Keighley MR. Randomized multicentre trial of oral bowel preparation and antimicrobials for elective colorectal operations. Br J Surg. 1978 Sep;65(9):597–600. [PubMed]
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  • Nichols RL, Condon RE, Gorbach SL, Nyhus LM. Efficacy of preoperative antimicrobial preparation of the bowel. Ann Surg. 1972 Aug;176(2):227–232. [PubMed]
  • Taylor SA, Cawdery HM, Smith J. The use of metronidazole in the preparation of the bowel for surgery. Br J Surg. 1979 Mar;66(3):191–192. [PubMed]
  • Washington JA, 2nd, Dearing WH, Judd ES, Elveback LR. Effect of preoperative antibiotic regimen on development of infection after intestinal surgery: Prospective, randomized, double-blind study. Ann Surg. 1974 Oct;180(4):567–572. [PubMed]
  • Willis AT, Ferguson IR, Jones PH, Phillips KD, Tearle PV, Fiddian RV, Graham DF, Harland DH, Hughes DF, Knight D, et al. Metronidazole in prevention and treatment of bacteroides infections in elective colonic surgery. Br Med J. 1977 Mar 5;1(6061):607–610. [PMC free article] [PubMed]

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