Optimum Duration of Prophylactic Antibiotics in Acute Non‐perforated Appendicitis

Abstract

Single dose of preoperative antibiotics is adequate for prevention of postoperative infective complications in patients with non-perforated appendicitis undergoing open appendicectomy. Prolonging the use of antibiotics can lead to unnecessary antibiotic related complications.

The use of pre- or postoperative antibiotics in surgery for appendicitis: A systematic review

“…A single-dose cefotetan was equally effective as multiple-dose cefoxitin according to the study by Liberman et al (14). (11)(12)(13)(14) and duration of IV antibiotics in cases of non-perforated appendicitis (14,15). there were no rcts found comparing different regimens of antibiotic prophylaxis specifically regarding perforated appendicitis.…”

“…Studies that separate simple or advanced/complicated appendicitis commonly include gangrenous appendicitis in the second group. on the contrary, the Mui et al trial (15) pooled together phlegmonous and gangrenous appendicitis. there was no study providing data on duration of antibiotic treatment of gangrenous appendicitis alone.…”

“…However, a single dose of cefotetan was as efficacious as the combined course of preoperative and postoperative cefoxitin. Mui et al (15) investigated wound infection rates in a three-armed rct including patients with non-perforated (both phlegmonous and gangrenous) appendicitis. one group (n = 92) received one preoperative dose of cefuroxime and metronidazole, another group (n = 94) received an additional three postoperative doses, and a third group (n = 83) received postoperative antibiotics for an additional five consecutive days.…”

Appendicitis in Children

“…In the presence of normal looking appendix, no further antibiotic is required. Single dose combined antibiotic therapy has been demonstrated to be adequate surgical prophylaxis in non-perforated appendicitis (Mui et al, 2005). In addition, Lee et al, (2010) observed that single or double agent antibiotics were effective and of lower cost than triple therapy.…”

“…This may create an environment that is favourable for the multiplication of exogenous pathogens as well as the overgrowth of select pathogenic strains. Antibiotic-related complications are common with use beyond 5 days (Mui et al, 2005). Principles for the selection of antibiotic therapy (Raftery, 2002) (Raftery, 2002).…”