The Use of Mechanical Bowel Preparation and Oral Antibiotic Prophylaxis in Elective Colorectal Surgery: A Call for Change in Practice

SIMPLE SUMMARY: Patients undergoing elective colorectal surgery are at a higher risk of surgical site infections (SSIs), which delay their recovery, lead to increased morbidity, and result in significant financial burden to the healthcare services. The World Health Organisation (WHO) recommends the use of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (OAP) to reduce the rates of SSIs. However, there remains international contention on this topic, and the National Institute of Clinical Excellence (NICE) currently recommends against the routine use of MBP and does not address the issue of OAP. We reviewed the current guidelines and most up-to-date evidence from randomised control trials (RCTs) and meta-analyses since the latest NICE guideline update. Recent evidence continues to favour the effectiveness of the combination of MBP and OAP in reducing SSI rates in elective colorectal surgery. ABSTRACT: Elective colorectal surgery is associated with one of the highest rates of surgical site infections (SSIs), which result in prolonged length of stay, morbidity, and mortality for these patients and have a significant financial burden to healthcare systems. In an effort to reduce the frequency of SSI rates associated with colorectal surgery, the 2018 World Health Organisation (WHO) guidelines recommend the routine use of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (OAP) in adult patients undergoing elective colorectal surgery. However, this recommendation remains a topic of debate internationally. The National Institute of Clinical Excellence (NICE) guidelines, last revised in 2019, recommend against the routine use of MBP and do not address the issue of OAP. In this communication, we reviewed the current guidelines and examined the most recent evidence from randomised-control trials (RCTs) and meta-analyses on the effect of MBP and OAP on SSI rates since the 2019 NICE guideline review. This recent evidence clearly demonstrated an SSI-risk-reduction benefit with the additional use of OAP and the combination of MBP and OAP in this group of patients, and we therefore highlight the need for change of the current NICE guidelines.