The value of antibiotic prophylaxis for gastrointestinal (GI) procedures has been debated for many years. Previously, antibiotic prophylaxis was recommended for many GI procedures in patients with high-risk cardiac conditions to protect against infective endocarditis. However, practices have substantially changed, in part due to the low incidence of infective endocarditis following GI procedures and the lack of randomized trials supporting the benefit of antibiotic prophylaxis. Furthermore, the indiscriminate use of antibiotics can be associated with the development of resistant organisms, Clostridium difficile colitis, unnecessary expense, and drug toxicity. (See "Clostridium difficile in adults: Epidemiology, microbiology, and pathophysiology", section on 'Antibiotic use' .)
Rectal Pulsed Irrigation, also known as “colonics”, colon hydro therapy and colon irrigation. Colonics are often promoted by Natural Health Practitioners for colon detoxification. A 30-minute infusion of short pulses of warm tap water via the rectum through a rectal tube immediately before the colonoscopy, combined with magnesium citrate 10oz (any color but red) given the evening before the colonoscopy is a reasonable alternative to full-volume (4-liters) Polyethylene glycol 3350 solutions (PEG) in those individuals who cannot tolerate oral administration of PEG. The disadvantages to this colon preparation is that its time consuming, requires skilled nursing to administer, and as a result it is expensive to use.
Should Patients Be Screened for MRSA to Determine if Vancomycin Should Be Used? The effect of preoperative identification and treatment of MRSA carriers on the incidence of surgical site infections is controversial. 28 – 30 The Medical Letter consultants acknowledge the controversy, but do not offer a recommendation. 8 Guidelines from the Society of Thoracic Surgeons recommend routine administration of topical mupirocin (Bactroban) for all patients undergoing cardiovascular procedures in the absence of documented tests negative for MRSA. 31 The American Academy of Orthopaedic Surgeons advises that patients at risk of colonization by methicillin-resistant or methicillin-sensitive S. aureus be screened and decolonized preoperatively. 32 Populations at risk of MRSA colonization may include patients recently discharged from a hospital or long-term care facility, patients with previous MRSA colonization or infection, patients with chronic hemodialysis, and intravenous drug users. 33