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Does adjuvant antibiotic treatment after drainage of anorectal abscess prevent development of anal fistulas? A randomized, placebo-controlled, double-blind, multicenter study.

Abstract

BACKGROUND

The risk of fistula formation is a major concern after incision and drainage of an anorectal abscess.

OBJECTIVE

Our objective was to the test the effects of antibiotic treatment on fistula formation after incision and drainage of anorectal abscesses.

DESIGN

Randomized, placebo-controlled, double-blind study.

SETTING

Multicenter trial at 3 teaching hospitals in Turkey.

PATIENTS

Patients who underwent abscess drainage between September 2005 and January 2008 were evaluated for eligibility. Exclusion criteria included penicillin allergy, antimicrobial agent usage before enrolment, other infection, previous anorectal surgery, inflammatory bowel disease, suspicion of Fournier gangrene, secondary and recurrent anorectal abscesses, anal fistula at time of the surgery, immune compromised states, and pregnancy.

INTERVENTION

Patients were randomly assigned to receive placebo or amoxicillin-clavulanic acid combination treatment for 10 days after abscess drainage.

MAIN OUTCOME MEASURES

The primary end point was rate of anorectal fistula formation at 1-year follow-up.

RESULTS

: Of 334 patients assessed for eligibility, 183 entered the study (placebo, 92; antibiotics, 91). Data were available for per-protocol analysis from 151 patients (placebo, 76; antibiotics, 75) with a mean age of 37.6 years; 118 patients (78.1%) were men. Overall, 45 patients (29.8%) developed anal fistulas during 1-year follow-up. Fistula formation occurred in 17 patients (22.4%) in the placebo group and in 28 patients (37.3%) in the antibiotic group (P = .044). Risk of fistula formation was increased in patients with ischiorectal abscess (odds ratio, 7.82) or intersphincteric abscess (odds ratio, 3.35) compared with perianal abscess.

CONCLUSION

Antibiotic treatment following the drainage of an anorectal abscess has no protective effect regarding risk of fistula formation.

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  • Authors+Show Affiliations

    ,

    Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey. ayhankuzu@yahoo.com

    , , , , , ,

    Source

    Diseases of the colon and rectum 54:8 2011 Aug pg 923-9

    MeSH

    Abscess
    Adolescent
    Adult
    Aged
    Amoxicillin-Potassium Clavulanate Combination
    Anal Canal
    Anti-Bacterial Agents
    Anus Diseases
    Chemotherapy, Adjuvant
    Double-Blind Method
    Drainage
    Female
    Humans
    Intestinal Fistula
    Logistic Models
    Male
    Middle Aged
    Rectal Diseases
    Young Adult

    Pub Type(s)

    Journal Article
    Multicenter Study
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    21730779