Effect of a Standardized Protocol of Antibiotic Therapy on Surgical Site Infection after Laparoscopic Surgery for Complicated Appendicitis

Abstract

In patients undergoing laparoscopic surgery for complicated appendicitis, five days of cefuroxime and metronidazole did not lead to more SSIs, and it decreased the medical costs compared with non-standardized antibiotic regimens.

Short-Course Versus Long-Course Antibiotic Therapy For Complicated Appendicitis: A Meta-analysis

“…A total of fifty studies were identified after the search, and the abstracts of these articles were reviewed. Only five full text articles were found to be pertinent to the review after methodological assessment (1 RCT 14 , 4 cohort studies 8,9,15,16 ). Figure 1 shows the process of identification, screening, and inclusion of studies in this systematic review.…”

“…Evidence-based guidelines for antibiotic treatment of complicated appendicitis recommend the administration of antibiotics for 5-7 days after surgery to reduced wound and organ-space infections. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Although variability exist on the timing of sequential therapy, most studies showed that after at least 24 hours of intravenous antibiotic therapy, shifting to oral antibiotic therapy is safe once the patient has improvement in clinical parameters such as absence of fever, decreasing leukocytosis, and return of normal gastrointestinal function. 1,2 However, a study on shortened antibiotic treatment showed no significant difference in infectious complications between a two-day course of antibiotic treatment and a four-day course of antibiotic treatment among patients with complicated intra-abdominal infections after their index sourcecontrol procedure.…”

“…Park, et al conducted a study among patients who underwent laparoscopic appendectomy for complicated appendicitis, and reported that there was no difference in surgical site infection rates between the group who had received various antibiotic regimens (triple-agent therapy covering gram-positive, gram-negative, and anaerobic organisms) for a prolonged duration (10 days) and the group who received a standardized drug protocol (Cefuroxime and Metronidazole) for 5 days. 8 A study by Hughes, et al 15 showed that the length of antibiotic course (≤5 days versus >5 days) was not associated with a significant difference in the incidence of intra-abdominal abscess after appendectomy.…”

“…1,[3][4][5] However, various single and combination antibiotic therapies with different durations have been recommended worldwide by various surgical infection societies for complicated appendicitis. 3,[6][7][8][9] While the guidelines by the Infectious Diseases Society of America and the Surgical Infection Society both had recommend limiting the duration of postoperative antibiotics for complicated intra-abdominal infections to 4 to 7 days 10 , several studies have shown that there are practitioners who extend their antibiotic use to 10 to 14 days. 11,12 The Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial provided evidence that a fixed short-course duration of four days antibiotic treatment resulted in outcomes similar to those of a longer course.…”

Comparison of Laparoscopic Appendectomy with Open Appendectomy with Respect to Surgical Site Infection

“…As a result, several studies' findings were influenced by the expertise and skill of surgeons 17 . For many treatments, including cholecystectomy, laparoscopic surgery has lately acquired widespread acceptability because it provides advantages like reduced scarring, less pain, and an earlier return to normal activities 18 . The first LA was carried out by German gynaecologist Semm in 1981 19 .…”