Abstract
Introduction: Several studies have shown benefit from use of preoperative antibiotics in reducing postoperative infection after appendectomy as well as efficacy of postoperative antibiotics in complicated appendicitis (defined as perforated appendix or presence of pus in peritoneum). While for uncomplicated appendicitis, several studies showed no benefit from antibiotics postoperatively but there are no clear NICE guidelines in UK till now and so surgeons have different practice based on their preferences.
Aim: The aim of this study is to find whether administration of postoperative antibiotics in uncomplicated appendicitis was superior to non-administration or not regarding 30-day postoperative wound infection or collection
Methods: This study included patients who had appendectomy for uncomplicated appendicitis in Worthing hospital from 1st July 2019 till 30th June 2020. The end point was 30-day follow up postoperatively for wound infection or collection.
Results: 90 patients were admitted with uncomplicated appendicitis with age 6-80 years (mean of 31.3). 46 patients (51%) did not receive postoperative antibiotics (group A) and 44 (49%) received postoperative antibiotics (group B) with a variable practice from one dose to 8-day course. postoperatively, only 1 patient (2.1%) in group A developed wound infection requiring drainage while none in group B developed complications (p-value=1).
Conclusion: Administration of postoperative antibiotics in uncomplicated appendicitis showed no superiority over non-administration. in addition, they add extra cost on NHS. So, their routine use postoperatively is not recommended, however, larger studies are required to confirm this.
Keywords: Acute appendicitis, uncomplicated appendicitis, antibiotics, postoperative wound infection.
References
- Baird, D.L.H., Simillis, C., Kontovounisios, C. et al.(2017) Acute appendicitis. BMJ 357, 1-6.
- Gorter, R.R., Eker, H.H., Gorter-Stam, M.A.W. et al.(2016) Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surgical Endoscopy 30(11), 4668-4690.
- Rentea, R.M., St Peter, S.D. and Synder, C.L. (2017) Pediatric appendicitis: state of the art review. Pediatric Surgery International33(3), 269-283.
- Bhangu, A., Soreide, K., Di Saverio, S. et al. (2015) Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet386(10000), 1278-1287.
- Howell, E.C., Dubina, E.D. and Lee, S.L. (2018) Perforation risk in pediatric appendicitis: assessment and management. Pediatric Health Medicine and Therpeutics9, 135-145.
- Stringer, M.D. (2017) Acute appendicitis. Journal of Paediatrics and Child Health53(11), 1071-1076.
- Synder, M.J., Guthrie, M. and Cagle, S. (2018) Acute appendicitis: efficient diagnosis and management. American Family Physician98(1), 25-33.
- Kevin M Schuster, Daniel N Holena, Ali Salim et al (2018)American Association for the Surgery of Trauma emergency general surgery guideline summaries: acute appendicitis, acute cholecystitis, acute diverticulitis, acute pancreatitis, and small bowel obstruction
- Daskalakis, C. Juhlin, L. Påhlman (2014)The use of pre- or postoperative antibiotics in surgery for appendicitis: A systematic review.Scand J Surg103(1):14-20.
- Andersen BR, Kallehave FL, Andersen HK (2005) Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst ;3:CD001439.
- Allo, MD, Bennion, RS, Kathir, K (1999): Ticarcillin/clavulanate versus imipenem/ cilastatin for the treatment of infections associated with gangrenous and perforated appendicitis. Am Surg 65(2):99–104.
- Hopkins, JA, Wilson, SE, Bobey, DG (1994): Adjunctive antimicrobial therapy for complicated appendicitis: Bacterial overkill by combination therapy. World J Surg 18(6):933–938.
- Berne, TV, Yellin, AE, Appleman, MD (1996): Meropenem versus tobramycin with clindamycin in the antibiotic management of patients with advanced appendicitis. J Am Coll Surg 182(5):403–407.
- Banani, SA, Talei, A (1999): Can oral metronidazole substitute parenteral drug therapy in acute appendicitis? A new policy in the management of simple or complicated appendicitis with localized peritonitis: A randomized controlled clinical trial. Am Surg65 (5):411–416.
- Taylor, E, Berjis, A, Bosch, T (2004): The efficacy of postoperative oral antibiotics in appendicitis: A randomized prospective double-blinded study. Am Surg 70(10): 858–862.
- Di Saverio, S., Podda, M., De Simone, B. et al.(2020) Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jesusalem guidelines. World Journal of Emergency Surgery 15(1), 1-42.
- Liberman, MA, Greason, KL, Frame, S (1995): Single-dose cefotetan or cefoxitin versus multiple-dose cefoxitin as prophylaxis in patients undergoing appendectomy for acute nonperforated appendicitis. J Am Coll Surg;180(1):77–80.
- Mui, LM, Ng, CS, Wong, SK (2005): Optimum duration of prophylactic antibiotics in acute non-perforated appendicitis. ANZ J Surg;75(6):425–428.
Corresponding Author
Nada Ayoub
Department of General Surgery, Western Sussex Hospitals, Worthing Hospital
DOI: https://dx.doi.org/10.18535/jmscr/v8i11.97
