Prophylactic antibiotics in uncomplicated appendicitis during childhood--a prospective randomised study.
544 children operated upon for uncomplicated appendicitis were randomised into three groups. Group I received no antibiotics, patients in Group II were administered one single pre-operative dose of metronidazole (10 mg/kg) and patients in Group III received both both metronidazole (20 mg/kg) and cefuroxime (50 mg/kg) in a single preoperative dose. The rate of infectious complications in Group I was 6.3% but only 2.1 and 2.3 in Groups II and III, respectively. Among patients with a normal appendix or patients with simple appendicitis there was no difference in the rate of post-operative infections between the three different groups. However, in patients with gangrenous appendicitis the rate of postoperative infections was significantly lower in the two groups who received preoperative antibiotics (1.8% and 3.0% respectively) than in the group receiving no prophylactic antibiotics (infection rate 14%). It is concluded that a single preoperative dose of metronidazole significantly decreases the rate of postoperative infectious complications in children with appendicitis. No further improvement could be demonstrated if cefuroxime against aerobic organisms was added.
Söderquist-Elinder
C
C
Department of Paediatric Surgery, St. Göran's Children's Hospital, Karolinska Institute, Stockholm, Sweden.
Hirsch
K
K
Bergdahl
S
S
Rutqvist
J
J
Frenckner
B
B
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001064:Appendicitis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D001065:Appendix / Q000473:pathology; D001424:Bacterial Infections / Q000517:prevention & control; D002097:C-Reactive Protein / Q000032:analysis; D002444:Cefuroxime / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002648:Child; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005734:Gangrene; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D008795:Metronidazole; D002097:C-Reactive Protein; D002444:Cefuroxime