Oral antibiotics before colorectal surgery?

Most patients undergoing elective colorectal surgery will have an uncomplicated postoperative course. For some, however, their lives will be affected by potentially life threatening surgical site infection requiring readmission to hospital, and the decreased quality of life associated with, for example, a stoma.1 For this reason extensive research has been performed on ways to decrease the risk of surgical site infection after colorectal surgery.2The perioperative use of prophylactic oral antibiotics has been studied for over 60 years,34 following the dogma of maximising the reduction of bacterial bioburden in the gut lumen.5 The same principle guides mechanical bowel preparation and enemas. Despite this dogma, the effects of either intervention on the gut microbiome and the effects of the gut microbiome on risk of surgical site infection are only recently being investigated.56In a linked paper, Futier and colleagues (doi:10.1136/bmj-2022-071476) report a multicentre placebo controlled trial in 11 French hospitals on the efficacy…
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