Antibiotics for the Treatment of Haemorrhoidal Disease: the Cons and the Pros

Introduction. Haemorrhoidal disease is probably the most common pathological condition; it leads to high morbidity and seriously impacts the patients' lifestyle. Surgery for haemorrhoids is a naturally contaminated procedure that may require antibiotic prophylaxis to lower the risk of infection. However, little data are available emphasizing antibiotic use for this condition.

Methods. Eighty-two patients participated in the study following a selection and exclusion procedure. Among them, 51.2% were female, and 48.8% were male, with a mean age of 49.4 ± 12.8 years. The prevalence of preoperative risk factors for surgical site infection included 18.3% with a smoking history, 6.1% with diabetes mellitus type II, 2.43% receiving systemic steroids, and 3.7% with other local factors including IBD. All patients underwent multimodal treatment (conservative and surgery). All surgeries performed were hemorrhoidectomies, predominately for classic 3-column (left lateral, right anterior, and right posterior positions), prolapsed internal, and mixed internal and external hemorrhoid disease. Single administration or a short duration (one-day) of antibiotic prophylaxis was employed. Oral doxycycline 100 mg or Levofloxacin 500 mg were used.

Results. Antibiotic prophylaxis was used in an approximately same number of surgeries (46.3% vs 53.7%, closed and open procedures, respectively). Overall, there were only 2.43% of documented postoperative infections identified. All those patients who developed postoperative surgical site infections did not receive antibiotic prophylaxis. However, no perioperative risk factor was reliably associated with an increased risk of developing a surgical site infection after hemorrhoidectomies. In addition, there were no adverse antibiotic-related complications such antibiotic-associated diarrhoea or C. deficile colitis in patients receiving antibiotic prophylaxis.

Conclusions. The study results are confusing, probably because of low rate of the surgical site infection following hemorrhoidectomies. Conversely, no patients with antibiotic prophylaxis demonstrated postoperative surgical site infection, and from this point of view its use appears plausible. Further studies with significantly larger involvement of patients may clarify the issue.