Comparative Study of Augmentin versus Metronidazole/Gentamicin in the Prevention of Infections after Appendicectomy

Abstract

Augmentin as single agent was compared to the combination of metronidazole/gentamicin in the prevention of sepsis after appendicectomy. Two hundred patients admitted to Riyadh Central Hospital with a clinical diagnosis of acute appendicitis were enrolled in a prospective randomized study. All patients had a preoperative chest X ray, CBC, urinalysis and any other necessary investigations. Patients received either drug regime intravenously, 30 min prior to surgery. The overall incidence of wound infections in the Augmentin group was 8% as compared to 14 % in the metronidazole/gentamicin group. There were no intra-abdominal abscesses in either group. Patients with perforated or gangrenous appendices received a 3- to 5-day course of treatment. All the early wound infection (2–4 days after operation) occurred in patients with gangrenous or perforated appendices. The results were studied statistically using χ² and there was no statistically significant difference between the infection rates in the two treatment groups whatever the state of the appendix at operation. Augmentin is as effective and well-tolerated as metronidazole/gentamicin in the prevention of wound infection following appendicectomy. The ease of administration of one drug with added antian-aerobic property makes Augmentin superior to the tested combination.

Metronidazole in Acute Non-perforated Appendicitis

“…The overall incidence of wound infections in a study in the amoxicillin plus clavulanic acid group was 8% as compared to 14% in the metronidazole/gentamicin group. 16 In our study, we also found no benefit of adding metronizadole in preventing wound infections.…”

“…Risk of wound infection by gram positive cocci is the greatest, and the use of metronidazole remained controversial. 16 al-Dhohayan A et al reported amoxicillin plus clavulanic acid to be as effective and well-tolerated as metronidazole/gentamicin in the prevention of wound infection following appendicectomy. The overall incidence of wound infections in a study in the amoxicillin plus clavulanic acid group was 8% as compared to 14% in the metronidazole/gentamicin group.…”

Prospective Multicenter Study of Antibiotic Prophylaxis in Operative Treatment of Appendicitis

“…An analysis of the data on conventional appendectomies published between 1992 and 1998 permits us to make the following statements [12, 21, 22, 23, 24, 25, 26, 27]: (1) Antibiotic prophylaxis is essential. (2) The infection rates for children are lower than for adults.…”

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…In most of the studies of second-or third-generation cephalosporins or metronidazole combinations, a single dose [376][377][378]380,383 or two or three doses 364,379,382 were given. Although direct comparisons were not made, there was no discernible difference in postoperative SSI rates between single-dose and multidose administration in most studies.…”