Optimum duration of prophylactic antibiotics in acute non-perforated appendicitis.
BACKGROUND
The effect of extended prophylactic antibiotic therapy on postoperative infective complications such as wound infection and intra-abdominal abscess for non-perforated appendicitis is poorly defined.


METHODS
In a randomized controlled trial of 269 patients aged 15-70 years with non-perforated appendicitis undergoing open appendicectomy; 92 received single dose preoperative (group A), 94 received three-dose (group B) and 83 received 5-day perioperative (group C) regimens of cefuroxime and metronidazole. Postoperative infective complication was the primary endpoint. Secondary outcomes included length of hospital stay and complications related to antibiotic therapy.


RESULTS
The rate of postoperative infective complication was not significantly different among the groups (6.5% group A, 6.4% group B, 3.6% group C). The duration of antibiotic therapy had no significant effect on the length of hospital stay. Complications related to antibiotic treatment were significantly more common for 5-day perioperative antibiotic group (C) compared with single dose preoperative antibiotic group (A) (P = 0.048).


CONCLUSIONS
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.
Mui
Lik Man
LM
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
Ng
Calvin S H
CS
Wong
Simon K H
SK
Lam
Yuk-Hoi
YH
Fung
Terence M K
TM
Fok
Kar-Lung
KL
Chung
Sydney S C
SS
Ng
Enders K W
EK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D002444:Cefuroxime / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011292:Premedication; D013530:Surgical Wound Infection / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D008795:Metronidazole; D002444:Cefuroxime