Topical ampicillin in the appendicectomy wound: Report of double-blind trial

Rickett, J W S; Jackson, Barbara

doi:10.1136/bmj.4.5677.206

Cited by 76 publications

(25 citation statements)

References 15 publications

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“…Many workers have shown that a reduction in the incidence of wound infection can be attained by the use of topical ampicillin powder (Rickett and Jackson, 1969), povidone iodine spray (Gilmore et al, 1973), or irrigation of the wound with tetracycline D. A. Leigh, Kate Simmons, and Edelgard Norman solution (Longland, Gray, Lees, and Garrett, 1971;Benson, Brown, and Whittaker, 1973). The use of parenteral chemotherapy with penicillin, streptomycin, ampicillin, or tetracycline has not been shown to be successful in preventing wound infection (Magarey et a!, 1971;Longland et al, 1971), but three of these antibiotics have a very limited activity against bacteroides and the incidence of tetracycline resistance is relatively high.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative wound infection has been reported in up to 30% of cases (Lancet, 1971) and this incidence can be influenced by many factors, the most important being surgical skill and technique and the criteria used to define the infection. Bacteria play an important role in appendicitis and the local application of antibiotics (Forbes, 1961;Rickett and Jackson, 1969) or antiseptics (Gilmore, Martin,and Fletcher, 1973) can reduce the incidence of wound infection. Despite the large number of studies into the infective complications of appendicitis, few workers have produced a detailed description of the associated bacteriology, and anaerobic bacteria which account for over 90 % of the bacterial population of the intestine have rarely been reported.…”

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confidence: 99%

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Bacterial flora of the appendix fossa in appendicitis and postoperative wound infection

1974

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SYNOPSIS Bacteria were isolated from 153 (47-5 %) swabs of the appendix fossa in 322 patients undergoing appendicectomy. The commonest organism was Bacteroides species found in 78 of specimens. Other Gram-negative bacilli such as Klebsiella, or Enterobacter, and Esch. coli were present in 29 and 27 % respectively. Gram-positive cocci were less frequently isolated.A positive culture was obtained more commonly in perforated appendicitis (79 %) than where chronic fibrosis, lymphoid hyperplasia, or acute appendicitis was present or when the appendix was normal. Bacteroides was isolated twice as often in perforated appendicitis.The incidence of wound infection was 19% and varied according to the state of the appendix, being 63 % in perforated appendicitis and 9 5 % where lymphoid hyperplasia was present. Bacteroides was isolated from over 90 % of the wound infections.In the patients with perforated appendicitis where effective chemotherapy was given the incidence of wound infection was 15 % whereas in untreated or inappropriately treated patients it was over 50%.The isolation of bacteroides requires special precautions to be taken both in the collection of the specimen and laboratory culture. It is important that the chemotherapy of postappendicectomy infections include an antibiotic active against bacteroides.Appendicitis is a common condition which frequently requires emergency surgery. Postoperative wound infection has been reported in up to 30% of cases (Lancet, 1971) and this incidence can be influenced by many factors, the most important being surgical skill and technique and the criteria used to define the infection. Bacteria play an important role in appendicitis and the local application of antibiotics (Forbes, 1961;Rickett and Jackson, 1969) or antiseptics (Gilmore, Martin,and Fletcher, 1973) can reduce the incidence of wound infection. Despite the large number of studies into the infective complications of appendicitis, few workers have produced a detailed description of the associated bacteriology, and anaerobic bacteria which account for over 90 % of the bacterial population of the intestine have rarely been reported. The relationship ofpreoperative bacterial flora of the peritoneal cavity surrounding the appendix to the degree of contamination is important in the development of wound infection. There is no agreement about the value of parenteral antibiotic treatment in acute appendicitis which

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Bacterial flora of the appendix fossa in appendicitis and postoperative wound infection

1974

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“…[5][6][7]11,12,16 Specifically, topical ampicillin was shown to reduce wound infection after colonic, 19 biliary and gastrointestinal surgery 20 and after appendectomy. 21,22 Ampicillin effectiveness is based on its activity against streptococci, enterococci and 30% of the E. coli isolates in our study. Its effectiveness against some aerobic and anaerobic bacteria has been also shown by hers.…”

Section: Discussionmentioning

confidence: 99%

Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

Alshehri

Saif

Aliyu

et al. 1994

Annals of Saudi Medicine

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A total of 249 patients, undergoing appendectomy for acute appendicitis, were prospectively randomized into two groups. Group I, comprising 132 patients, received sterile normal saline irrigation to the surgical wound at closure. Alternatively, Group II included 117 patients, who received intraoperative topical ampicillin irrigation of the wound. Both groups were comparable with regard to age, sex, duration of symptoms, and severity of appendicitis. All patients additionally received preoperative systemic gentamicin and Flagyl. Wound infection occurred in 5.3% of Group I compared to only 0.9% of Group II (P<0.05). The reduction in infection rate was significant (P<0.05) in histologically proven appendicitis. We conclude that the addition of intraoperative topical ampicillin to systemic gentamicin and Flagyl augments prophylaxis against wound infection in acute appendicitis. Ann Saudi Med 1994;14(3):233-236. A considerable morbidity following appendectomy is caused by wound infection, 1-5 the rate of which ranges from 9% to 30% in early appendicitis and may reach up to 70% in advanced appendicitis.3-6 Systemic antibiotics were shown to reduce the wound infection rate significantly. 3,4,7 In vitro studies demonstrated 100% kill rates with clinically usable concentrations of antimicrobials in irrigating solutions after only 60-second exposure of the organisms. 8,9 Unlike parenterally administered antimicrobials, topical usage was found to attain prolonged effective local concentrations when used in the powder form. 10Experimental studies have shown that the combined use of systemic and topical antibiotics is better in advanced appendicitis than systemic antibiotics alone.11 Similarly, Seco et al. 12 have concluded in a clinical study that prophylaxis with a combination of systemic clindamycin and topical ampicillin solution, when compared with systemic clindamycin alone, was more effective in preventing wound infection after appendectomy, especially in patients with high wound contamination. However, the study of Seco et al. was criticized because the control group wounds were not irrigated with normal saline and clindamycin may not be the systemic antibiotic of choice for many surgeons. This communication aims at investigating the efficacy of the addition of topical ampicillin to systemic antimicrobials in reducing post appendectomy wound infection rate in a properly controlled randomized prospective study. Material and MethodsAll patients who underwent appendectomy through gridiron incision for clinically suspected acute appendicitis were considered for the study. Exclusion criteria were allergy to ampicillin and other systemic diseases requiring systemic antibiotic administration and therefore three patients who were allergic to ampicillin were excluded from the study, as well as another two patients who had valvular heart disease warranting preoperative prophylactic systemic ampicillin in addition to the systemic gentamicin and Flagyl. A total of 254 patients fulfilled the criteria of the study and were random...

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“…The topical application of ampicillin powder to appendicectomy wounds has been shown to reduce the incidence of postoperative wound infection (Rickett and Jackson, 1969;Mountain and Seal, 1970). However, its value is not as yet widely accepted and further controlled trials have been suggested (Leading article, 1971).…”

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confidence: 99%