A Prospective Randomized Trial to Compare One Dose Preoperative, Three‐dose Perioperative and 5‐day Full Course Antibiotics for Non‐perforated Acute Appendicitis

Abstract

Background: Although prophylatic antibiotics has been proven to be effective in reducing wound complications after appendectomy, the most efficacous dosage remains uncertain. Aim: To determine the optimal duration of antibiotics after appendectomy for non‐perforated acute appendicitis. Methods: From July 1995 to December 2000, all patients aged between 15 and 70 years with appendectomy performed via a right lower abdominal incision were considered for the study. Exclusion criteria included pre‐admission antibiotics, diabetes mellitus, known drug allergy and ruptured appendicitis. Intravenous Cefuroxime, 1.5g, and Metronidazole, 500 mg were given at induction of anaesthesia. After appendectomy, patients were randomized to one of the three treatment protocols: (A) no further antibiotics, (B) 2 more doses of antibiotics, or (C) a 5‐day course of antibiotics. Outcomes of surgery were compared using 1‐way ANOVA or Chi‐square where appropriate. Results: Of 275 patients recruited, 6 had normal appendix revealed by histology and were excluded. Treatment A, B and C were assigned to 92, 94 and 83 patients, respectively. The 3 groups were comparable in demographics and pre‐operative characteristics. The outcomes were as follows: Conclusions: A single dose of preoperative antibiotics is adequate for prevention of wound infection in non‐perforated appendicitis. Prolonged use of antibiotics is cost‐ineffective and may lead to unnecessary complications.

Acute Appendicitis, a Quality of Care Study in Basrah General Hospital

“…In our study it is impossible to determine the incidence of negative appendectomies because appendix subjected to histopathological examination in only 7(6.35%) patients. Perforation of appendix found in 14(12.7%) patients, different rates of perforation ranging between 10% to 39% mentioned in different articles 6,[10][11][12][13][14] . The usage of drain is usually unnecessary if adequate toilet has been done 7 , but it is still used in our patients although on small scale (5.45%).The mean hospital stay was 44 hours, 36.4 hours for those with nonperforated appendicitis and longer than 84 hours for those with perforated appendicitis or with complications.…”

A randomized control trial to determine the need for postoperative antibiotics after laparoscopic appendicectomy in nonperforated appendicitis

“…Correspondingly, a RCT conducted by Mui et al, concluded that the single dose of perioperative antibiotic is adequate for prevention of infective wound complications in patients undergoing surgery for uncomplicated appendicitis. 26 They also concluded that the prolonged antibiotic administration was cost-ineffective and leads to unnecessary complications. Few other studies in the literature also reported that that single dose of prophylactic antibiotic is enough to prevent infective complications following appendicectomy for nonperforated appendicitis.…”