title: Antibiotics versus placebo for prevention of postoperative infection after appendectomy.
abstract: BACKGROUND
  Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. The cause of appendicitis is unclear and the mechanism of pathogenesis continues to be debated. Despite improved asepsis and surgical techniques, postoperative complications, such as wound infection and intraabdominal abscess, still account for a significant morbidity. Several studies implicate that postoperative infections are reduced by administration of antimicrobial regimes.
  
  
  OBJECTIVE
  The objective of this review is to compare the use of antibiotics with placebo or no treatment in patients undergoing appendectomy. Will these patients benefit from antimicrobial prophylaxis? The outcomes are described according to the nature of the appendix, as either simple appendicitis (including the non-infectious stage) and complicated appendicitis. This review do not attempt to compare the effect of different regimens, a clinical question that is addressed in another review undertaken by this Group (CCCG).
  
  
  METHODS
  We searched The Cochrane Controlled Trials Register (Cochrane Library 2000 issue 4), Medline (January 1966 to September 2000), Embase and the Cochrane Colorectal Cancer Group specialised register (September 2000). In addition we manually searched the reference lists of the primary identified trials.
  
  
  METHODS
  Randomised Controlled Trials (RCT) and Controlled Clinical Trials (CCT) in which any antibiotic regime were compared to placebo in patients suspected of having appendicitis undergoing appendectomy were evaluated. Both studies on children and adults were reviewed. The outcome measures of the studies were either wound infection, intraabdominal abscess, length of stay in hospital or mortality.
  
  
  METHODS
  Eligibility and trial quality were assessed, recorded and cross-checked by to reviewers.
  
  
  RESULTS
  Forty-four studies including 9298 patients were included in this review. The overall result is that use of antibiotics is superior to placebo for the outcome wound infection and intraabdominal abscess, with no apparant difference in the nature of the removed appendix. Studies exclusively on children and studies examining topical application reported results in favour to the above although the results were not significant.
  
  
  CONCLUSIONS
  Antibiotic prophylaxis is effective in the prevention of postoperative complications in appendectomised patients, whether the administration are given pre-, per- and post-operatively and could be considered for routine in emergency appendectomies.
authors.affiliation: Department of Surgical Gastroenterology K, H:S Bispebjerg Hospital, 23 Bispebjerg Bakke, Copenhagen NV, Denmark, DK 2400. cccg@cccg.dk
authors.forename: B R
authors.initials: BR
authors.lastname: Andersen
authors.forename: F L
authors.initials: FL
authors.lastname: Kallehave
authors.forename: H K
authors.initials: HK
authors.lastname: Andersen
mesh_terms: D018784:Abdominal Abscess / Q000517:prevention & control*; D000328:Adult; D019072:Antibiotic Prophylaxis; D001062:Appendectomy / Q000009:adverse effects*; D001064:Appendicitis / Q000601:surgery; D002648:Child; D018849:Controlled Clinical Trials as Topic; D006801:Humans; D007902:Length of Stay; D011183:Postoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control