One-dose antibiotic prophylaxis against wound infection after appendicectomy: A randomized trial of clindamycin, cefazolin sodium and a placebo

Abstract

Two hundred and fifty patients were admitted to a prospective randomized trial of single dosage prophylaxis against wound infection after appendicectomy. There were 12 exclusions, 72 patients received placebo, 81 received 600 mg i.m. clindamycin phosphate and 85 received 1 1 g i.m. cefazolin sodium, the agent being given in the anaesthetic room. Clindamycin produced a significant reduction in the overall rate of wound infection from 33 per cent in the controls to 17 per cent. In cases with a gangrenous or perforated appendix the infection rate in controls was 78 per cent; this was reduced to 44 per cent by a single dose of clindamycin. Cefazolin significantly reduced the number of aerobic organisms isolated from wound infections, but did not significantly reduce the incidence of wound infection. We conclude that anaerobic organisms are more important than faecal aerobic organisms in the pathogenesis of wound infection after appendicectomy.

Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

“…[4][5][6][7] Prophylactic use of systemic antibiotics, many of which have been used either alone or in combination, has resulted in a significant reduction in wound infection rate. [2][3][4] Gentamicin is effective against E. coli, which was the most common aerobic organism cultured from the wound and abdomen in our study and this is in agreement with previous studies. 16,17 Unfortunately, culture for anaerobes was not carried out in our study in view of lack of facilities in the emergency setting of our hospital.…”

“…A considerable morbidity following appendectomy is caused by wound infection, [1][2][3][4][5] the rate of which ranges from 9% to 30% in early appendicitis and may reach up to 70% in advanced appendicitis. [3][4][5][6] Systemic antibiotics were shown to reduce the wound infection rate significantly.…”

“…[3][4][5][6] Systemic antibiotics were shown to reduce the wound infection rate significantly. 3,4,7 In vitro studies demonstrated 100% kill rates with clinically usable concentrations of antimicrobials in irrigating solutions after only 60-second exposure of the organisms. 8,9 Unlike parenterally administered antimicrobials, topical usage was found to attain prolonged effective local concentrations when used in the powder form.…”

Open appendectomy for pediatric ruptured appendicitis: a historical clinical review of the prophylaxis of wound infection and postoperative intra-abdominal abscess

“…5,[9][10][11][12][14][15][16][17][18] Although some reports (both adult and pediatric, often combined) indicate that some form of antibiotic prophylaxis will diminish the incidence of both complications, 35,[37][38][39][40][41][42][43][44][45][46][47][48][49][50] others claim it makes no difference. 5,23,24,[27][28][29][30][31][32][33]36,[51][52][53][54] In our series, each ruptured appendix at operation had an obvious perforation confirmed by histopathological examination. The amount of peritoneal contamination varied between a small localized area in the right lower quadrant (15%) and gross contamination throughout the peritoneal cavity (85%).…”

“…5,31,64,65 The authors also focused on the specific antibiotic treatment of anaerobic bacteria, especially Bacteroides fragilis. 27,32,40,66,67 However, the drawback of their paper was that patients with unruptured gangrenous appendicitis were also included in their study of ruptured appendicitis, and including those patients improved their results.…”