Mark L. Welton, MD, Stanford, Calif: Drs Wren and Safadi retrospectively reviewed 304 patients undergoing elective colectomy at a veterans hospital over a 78-month period of time in an effort to determine whether the standard nonabsorbable oral antibiotic preparation is of benefit when combined with intravenous antibiotics. As they note, it has long been the standard of care to require cathartic bowel preparation in combination with an oral antibiotic preparation. These recommendations were made initially in 1971 by Nichols and Condon, who cited historical evidence to prove the mechanical bowel preparation was mandatory. Subsequent trials until the early 1990s focused on types of bowel preparation, for example, mannitol, PEG [polyethylene glycol], saline, Fleet's Phospho-soda, inpatient vs outpatient bowel preparation, and choices of antibiotic therapy, and types of delivery, ie, first-generation, second-generation, third-generation cephalosporins or intravenous, oral, or intraperitoneal delivery of the antibiotics. In the early 1990s, a few trials began to focus on the importance of mechanical bowel preparation and, as Dr Wren just noted, in 2003, a Cochrane Analysis reported that there is no data to support mechanical bowel preparation. Indeed, it may in fact be harmful. This study details potential complications directly related to oral antibiotic usage. Dr Wren and colleagues found that Clostridium difficile colitis was more common in patients who received nonabsorbable antibiotics and intravenous antibiotics than those patients who received only parenteral antibiotic therapy. Overall, the authors found a postoperative Clostridium difficile infection rate of 4.3%. However, there was a significant difference between the 2 groups, 7.4% vs 2.6% in the oral and intravenous antibiotic group and intravenous antibiotics only group, respectively. Importantly, the wound infection rates were essentially the same, with a rate of 13.8% overall, and rates of 14.9% vs 13.2% for those that received oral and intravenous antibiotics vs those that received intravenous antibiotics alone, respectively.