A Single Prophylactic Antibiotic for Emergency Appendicectomy

Abstract

This paper reports the results of a prospective randomized study of antibiotic prophylaxis in 200 patients over the age of 12 years undergoing emergency appendicectomy at Al-Jala Hospital for Trauma and Emergency Surgery, Benghazi. We have compared the efficacy of ceftriaxone, a long-acting broad-spectrum cephalosporin with that of our routine regimen consisting of metronidazole, gentamicin and ampicillin, given together. Ceftriaxone was administered as a single pre-operative dose of 2 g (to be continued as a daily injection for 5 days in patients with perforated appendicitis). The triple combination was given on an 8-hourly basis for 3 days, extended to 5–7 days in cases of perforation. Patients receiving ceftriaxone did as well as or slightly better than those on the triple-antimicrobial regimen, in terms of wound infection rate (3 vs. 5%), incidence of transient post-operative pyrexia and duration of hospital stay (on average 4.5 vs. 5.9 days). More importantly, administering ceftriaxone as 1 injection per day led to a dramatic saving in terms of nursing effort and time (1 injection instead of 9 per 24 h) and of the daily financial cost of therapy per patient. It is concluded that the clinical results and economic implications seem to justify the use of ceftriaxone as a routine prophylactic antibiotic for patients undergoing emergency appendicectomy.

A Meta‐Analysis of Randomized, Controlled Trials Assessing the Prophylactic Use of Ceftriaxone. A Study of Wound, Chest, and Urinary Infections

“…1. After triage, there were 90 remaining studies that were included in the meta‐analysis [6–9, 12–96]. Of these 44 were sourced from Medline, an additional 8 from Embase, 10 from the Cochrane registers, 10 from scientific meetings, and 18 from identified references.…”

“…The comparison between ceftriaxone and other antibiotics in reducing SSI was analyzed in 64 studies ( n = 22,888 patients) [6–9, 12–70]. The funnel plot identified three studies that were on or outside the 95% confidence interval, all in favor of ceftriaxone, which were excluded from further analysis [44, 61, 64].…”

“…Odds ratio and 95% CI Alley [12] Anderson [13] Badel [14] Beam [69] Blatzas [15] Burdon [16] Cardamakis [17] Ciftci [18] dela Hunt [8] El-Mufti [20] Ef-Mufti [19] Ferraz [21] Fejgin [68] Fingerhut [22] Franceschini [23] Garcia [24] Garotta [25] Germiniani [70] Geroulanos [26] Geroulanos [27] Hall [29] Hall [28] Harnoss [30] Hemsell [31] Hjortrup [32] Hotz [33] Ilic […”