Metronidazole and Augmentin in the prevention of sepsis after appendicectomy

Abstract

Two hundred and fifty patients were admitted to a prospective randomized trial to compare the efficacy of Augmentin with metronidazole in the prevention of sepsis after appendicectomy. Pre-operatively they received either 500 mg metronidazole or 1.2g Augmentin intravenously. Those patients with gangrenous or perforated appendices received eight additional doses of the trial drug at 8 hourly intervals. Overall there were 13 wound infections in the Augmentin group (11 per cent) and 21 in the metronidazole group (18 per cent). The 90 per cent confidence limits for the overall 7 per cent difference in infection rates were +/- 8.5 per cent. There were high rates of wound infection in the gangrenous group (Augmentin 8 per cent versus metronidazole 19 per cent) and especially in the perforated group (Augmentin 33 per cent versus metronidazole 63 per cent). There was no statistically significant difference between the infection rates with the two antibiotics but our study suggests that Augmentin, which is active against both aerobes and anaerobes, may be more effective than metronidazole in reducing wound sepsis after appendicectomy.

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

“…Moreover, gentamicin blood levels should be monitored to avoid overdosing. This study confirmed studies carried out by Drum et al [12] where Augmentin was superior to metronidazole probably because of its added antianaerobic property. The advantages of Augmentin include ease of administration since the drug is given as a single agent.…”

Enterobiasis: threadworm infection presenting as acute appendicitis in a 13-year-old girl

“…Co-amoxiclav is preferred over metronidazole as it also covers anaerobes 2. There is literature highlighting the fact that a combination of metronidazole and mebendazole may cause Stevens-Johnson syndrome 3…”

Effectiveness of two therapeutic antibiotic regimens in the treatment of serious post‐operative infections

“…Augmentin is a broad spectrum antibiotic formulation of amoxycillin and the β‐lactamase inhibitor clavulanic acid. It is bactericidal for a wide spectrum of organisms 5 , including anaerobes, and is clinically successful in the reduction of post‐operative wound infections 6–8 . A single‐centre, randomised, prospective trial has been undertaken comparing intravenous Augmentin with an antibiotic regimen of similar antimicrobial activity (intravenous cefuroxime and rectal metronidazole) in the treatment of serious post‐operative infections.…”