The practical application of intestinal antisepsis to surgery of the colon and rectum.

THE CONCEPT of intestinal antisepsis is not new. I t was under taken without success in the preceding century. Not unti l 1941,20 with the discovery of succinylsulfathiazole, was a practical intestinal antiseptic available. T h e sulfa drugs are bacteriostatic-not bactericidal--agents. Consequently, they must be administered for a considerable period of t ime and the resident organisms must be removed from the bowel mechanically before significant al teration of the bacterial flora is erected. This course requires adminis trat ion of this general group of compounds for a m i n i m u m of five days. Although the delay constitutes a definite drawback, some surgeons still prefer sulfasuxidine. I began using neomycin, a broad spect rum antibiotic, as an intestinal antiseptic in the winter of 1949. TM Used alone, it appeared to be an excellent intestinal antiseptic and not until the following summer was it observed that Aerobacter aerogenes grew in increasing numbers in approximately 10 per cent of patients treated. 17 Sulfathalidine was ridded to suppress the outgrowth of this organism and now this combinat ion of neomycin and sulfathalidine constitutes an excellent intestinal antiseptic which has continued to be effective, is Other antibacterial agents and combinations of drugs have been suggested, but I have found that none are superior to neomycin-sulfathalidine. Neomycin is the basic constituent of practically all useful intes-