|
| Drug choice (dose) | Advantages | Disadvantages |
|
| Cefoxitin (1 g) | Low toxicity cephalosporin with many years of use for prophylaxis; aerobic and anaerobic coverage. | Short biological elimination half-life (45 min); concerns about gram negative resistance. |
| Cefotetan (1 g) | Low toxicity cephalosporin with many years of use for prophylaxis; aerobic and anaerobic coverage. Long biological elimination half-life (4 hr) | Concerns about gram negative resistance. |
Ampicillin/sulbactam
(1.5–3.0 g) | Extensively used penicillin with a beta-lactamase inhibitor; good anaerobic coverage. | Short biological elimination half-life (1 hr); emerging E. coli resistance in up to 40% of isolates. |
| Ertapenem (1 g) | Extended gram negative coverage (not Pseudomonas spp.); long biological elimination half-life (3.5 hr). | Expense. |
| Cefazolin (1 g) and metronidazole (500 mg) | Good bacteriological coverage of anticipated pathogens | Limited clinical data to show effectiveness in elective colon surgery |
| Cefuroxime (500 mg) and metronidazole (500 mg) | Good bacteriological coverage of anticipated pathogens | Limited clinical data to show effectiveness in elective colon surgery |
| Aminoglycoside (gentamicin or tobramycin; 1 mg/kg) and clindamycin (300–600 mg) | A good choice for patients needing extended gram negative coverage (e.g., nursing home patients) | Unpredictable aminoglycoside pharmacology. |
| Quinolone (ciprofloxacin; 500–750 mg, or levofloxacin; 500–750 mg) and clindamycin (300–600 mg) | Comprehensive antimicrobial coverage of anticipated pathogens. | Limited data to validate use for prophylaxis in elective colon surgery |
| Aztreonam (1 g) and clindamycin (300–600 mg) | Good antimicrobial coverage of anticipated pathogens. | Aztreonam has no gram positive coverage and should not be used with metronidazole |
| Aminoglycoside (gentamicin or tobramycin; 1 mg/kg) and metronidazole (500 mg) | A good choice for patients needing extended gram negative coverage (e.g., nursing home patients) | Unpredictable aminoglycoside pharmacology. |
| Quinolone (ciprofloxacin; 500–750 mg, or levofloxacin; 500–750 mg) and metronidazole (500 mg) | | |
|
