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. 1981 Oct;194(4):502–509. doi: 10.1097/00000658-198110000-00013

Effect of prophylactic antibiotics in acute nonperforated appendicitis: a prospective, randomized, double-blind clinical study.

R W Busuttil, R K Davidson, M Fine, R K Tompkins
PMCID: PMC1345331  PMID: 7025769

Abstract

A prospective, randomized, double-blind clinical study was performed to determined the efficacy of short-term (24 hr) perioperative antibiotics in preventing septic complications after emergency appendectomy for nonperforated appendicitis. The patients were stratified into three clinical arms: Group I (placebo, n = 45), Group II (cefamandole, n = 46) and Group III (cefamandole plus carbenicillin, n = 45). The three groups of patients were similar in regard to age, sex, duration of operation and pathologic classification of the appendix. The overall incidence of infection in the study was 5.1%. The infection rates in Groups II (2.2%) and III (0%) were significantly lower than Group I (placebo) (13.3%), (p less than 0.05). No difference was observed between cefamandole alone and cefamandole plus carbenicillin. Average postoperative hospital days per patient for each group was: Group I - 3.8 days; Group II - 2.9 days; Group III - 3.1 days. Cost analysis of hospitalization including cost of prophylactic antibiotics revealed a $247.99 per patient saving for Group II versus Group I and $95.53 for Group III versus Group I. Systemic prophylactic antibiotics can successfully reduce septic complications after appendectomy for nonperforated appendicitis, and a single drug (cefamandole) directed at the facultative pathogens is as effective as double drug therapy, which includes specific anaerobic coverage.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Donovan I. A., Ellis D., Gatehouse D., Little G., Grimley R., Armistead S., Keighley M. R., Strachan C. J. One-dose antibiotic prophylaxis against wound infection after appendicectomy: a randomized trial of clindamycin, cefazolin sodium and a placebo. Br J Surg. 1979 Mar;66(3):193–196. doi: 10.1002/bjs.1800660317. [DOI] [PubMed] [Google Scholar]
  2. Fine M., Busuttil R. W. Acute appendicitis: efficacy of prophylactic preoperative antibiotics in the reduction of septic morbidity. Am J Surg. 1978 Feb;135(2):210–212. doi: 10.1016/0002-9610(78)90100-9. [DOI] [PubMed] [Google Scholar]
  3. Foster P. D., O'Toole R. D. Primary appendectomy. The effect of prophylatic cephaloridine on postoperative wound infection. JAMA. 1978 Apr 3;239(14):1411–1412. doi: 10.1001/jama.239.14.1411. [DOI] [PubMed] [Google Scholar]
  4. Gilmore O. J., Martin T. D. Aetiology and prevention of wound infection in appendicetomy. Br J Surg. 1974 Apr;61(4):281–287. doi: 10.1002/bjs.1800610407. [DOI] [PubMed] [Google Scholar]
  5. Ivarsson L. E. Single-dose antibiotic prophylaxis in appendectomy. Acta Chir Scand. 1977;143(7-8):469–472. [PubMed] [Google Scholar]
  6. Leigh D. A., Pease R., Henderson H., Simmons K., Russ R. Prophylactic lincomycin in the prevention of wound infection following appendicectomy: a double blind study. Br J Surg. 1976 Dec;63(12):973–977. doi: 10.1002/bjs.1800631222. [DOI] [PubMed] [Google Scholar]
  7. Leigh D. A., Simmons K., Norman E. Bacterial flora of the appendix fossa in appendicitis and postoperative wound infection. J Clin Pathol. 1974 Dec;27(12):997–1000. doi: 10.1136/jcp.27.12.997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Pinto D. J., Sanderson P. J. Rational use of antibiotic therapy after appendicectomy. Br Med J. 1980 Feb 2;280(6210):275–277. doi: 10.1136/bmj.280.6210.275. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Polk H. C., Jr, Lopez-Mayor J. F. Postoperative wound infection: a prospective study of determinant factors and prevention. Surgery. 1969 Jul;66(1):97–103. [PubMed] [Google Scholar]
  10. Stone H. H., Hooper C. A., Kolb L. D., Geheber C. E., Dawkins E. J. Antibiotic prophylaxis in gastric, biliary and colonic surgery. Ann Surg. 1976 Oct;184(4):443–452. doi: 10.1097/00000658-197610000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Stone H. H., Kolb L. D., Geheber C. E. Incidence and significance of intraperitoneal anaerobic bacteria. Ann Surg. 1975 May;181(5):705–715. doi: 10.1097/00000658-197505000-00027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Tanphiphat C., Sangsubhan C., Vongvaravipatr V., La-Ongthong B., Chodchoy V., Treesaranuvatana S., Ittipong P. Wound infection in emergency appendicectomy: a prospective trial with tropical ampicillin and antiseptic solution irrigation. Br J Surg. 1978 Feb;65(2):89–91. doi: 10.1002/bjs.1800650206. [DOI] [PubMed] [Google Scholar]
  13. Wilkins T. D., Chalgren S. Medium for use in antibiotic susceptibility testing of anaerobic bacteria. Antimicrob Agents Chemother. 1976 Dec;10(6):926–928. doi: 10.1128/aac.10.6.926. [DOI] [PMC free article] [PubMed] [Google Scholar]

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