Single-dose intrarectal metronidazole prophylaxis against wound infection after appendectomy

The Continuing Challenge of Acute Appendicitis

“…In the pre-antibiotic era one third of pyogenic liver abscesses were secondary to appendici tis [117], but this and the associated problem of portal thrombophlebitis are now uncom mon [118], Antibacterial agents were first shown to reduce deaths from appendicitis in 1940 [119]. Bacteriological swabs usually produce a mixed growth with a predominance of anaerobes [111,120,121], Introduced in the 1970s, prophylactic antibiotic therapy has re duced the wound infection rate towards zero [122], and has become standard practice. There are numerous trials of antibiotic pro phylaxis in acute appendicitis, but the ideal choice at present would seem to be a single pre-operative dose of metronidazole [122], with the addition of an aerobicide if the appendix is found to be perforated or gangre nous at operation [123].…”

“…Bacteriological swabs usually produce a mixed growth with a predominance of anaerobes [111,120,121], Introduced in the 1970s, prophylactic antibiotic therapy has re duced the wound infection rate towards zero [122], and has become standard practice. There are numerous trials of antibiotic pro phylaxis in acute appendicitis, but the ideal choice at present would seem to be a single pre-operative dose of metronidazole [122], with the addition of an aerobicide if the appendix is found to be perforated or gangre nous at operation [123].…”

Invited commentary

“…A report the following year [2], however, showed the infection incidence in perforated cases to have risen to 3%. Pulaski [3], Foster [4], Busuttil [5], Kortelainen [6], and Winslow [7], and their colleagues, all have achieved infection rates of 1% or less in patients with appendicitis treated with a variety of antimicrobial drugs.…”

Standards of Antibiotic Prophylaxis in Abdominal Surgery

“…Differences in surgical technique and, most important, the duration of the operation affect the incidence of wound infection [78,79], Data from the Danish Multi center Group demonstrated a significant reduction in infection rates after appendicectomy when using a regi men as in colorectal surgery, though the formation of intra-abdominal abscesses is not influenced [75]. Con cerning the choice of the drug, metronidazole alone, given systemically or rectally as a single shot is an effective agent to prevent wound infection [20,80,81]. Topical antiseptics or antibiotics did not show a significant bene fit [82] but combinations seem to have some value in advanced appendicitis [83].…”