Systemic metronidazole combined with either topical povidone-iodine or ampicillin in acute appendicitis.
One-hundred consecutive patients undergoing appendicectomy either electively or for clinically diagnosed acute appendicitis were studied to examine the difference between the use of topical povidone-iodine (PVP-I) and ampicillin in the wound given at the time of closure. All patients were treated with metronidazole suppositories for 48 h starting at the time of pre-medication in addition to a topical agent. The overall wound infection rate was 14%. If the appendix was histologically normal or inflamed, the rate fell to 10% whereas if gangrenous or perforated it rose to 24%. Sixty-six per cent of the patients with a perforated appendicitis developed a wound infection. There was no significant difference in the wound infection rate between those treated with PVP-I and those with ampicillin. Topical antisepsis using PVP-I is preferable to ampicillin as it abolishes the risk of antibiotic resistance or allergy developing and since it is comparatively more cost-effective.
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D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D001062:Appendectomy; D002648:Child; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D011205:Povidone / Q000031:analogs & derivatives*; D011206:Povidone-Iodine / Q000008:administration & dosage / Q000627:therapeutic use*; D013530:Surgical Wound Infection / Q000517:prevention & control*
D000890:Anti-Infective Agents; D000891:Anti-Infective Agents, Local; D008795:Metronidazole; D011206:Povidone-Iodine; D011205:Povidone