Intervention Review

You have free access to this content

Antibiotics versus placebo for prevention of postoperative infection after appendicectomy.

  1. Betina Ristorp Andersen2,
  2. Finn Lasse Kallehave3,
  3. Henning Keinke Andersen1,*

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 20 JUL 2005

Assessed as up-to-date: 19 APR 2005

DOI: 10.1002/14651858.CD001439.pub2

How to Cite

Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy.. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD001439. DOI: 10.1002/14651858.CD001439.pub2.

Author Information

  1. 1

    Colorectal Cancer Group, Building 11 B,, Copenhagen, Denmark

  2. 2

    Hillerød University Hospital, Department of Obstetrics and Gynecology, Hillerød, Denmark

  3. 3

    Ålborg Hospital, Departement A, Surgical gastroenterology, Ålborg, Denmark

*Henning Keinke Andersen, Building 11 B,, Colorectal Cancer Group, 23 Bispebjerg Bakke, Copenhagen, DK 2400 CPH NV, Denmark.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JUL 2005



References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Ahmed 1987 {published data only}
  • Ahmed ME, Ibrahim SZ, Arabi YE, Hassan MA. Metronidazole prophylaxis in acute mural appendicitis: failure of a single intra-operative infusion to reduce wound infection. J Hosp Infect 1987;10:260-4.
Azabache 1987 A {published data only}
  • Azabache PW, Gonzales GV, Santa Maria RB. Antibioticoprofilaxis según tipo de herida postapendicectomía [Antibioticoprofilaxis según tipo de herida postapendicectomía]. Rev Gastroenterol (Peru) 1987;7:112-5.
Azabache 1987 B {published data only}
  • As Azabache 1987 A.
Bates 1980 {published data only}
Bauer 1989 {published data only}
Bergmark 1985 {published data only}
  • Bergmark C, Lahnborg G. Prophylactic trimethoprim-sulpha plus metronidazole in appendectomy - a controlled study. Opmear 1985;30(3):93-5.
Browder 1989 A {published data only}
Browder 1989 B {published data only}
  • As Browder 1989 A.
Busuttil 1981 A {published data only}
  • Busuttil RW, Davidson RK, Fine M, Tompkins RK. Effect of prophylactic antibiotics in acute nonperforated appendicitis: a prospective, randomized, double-blind clinical study. Ann Surg 1981;194(4):502-9.
Busuttil 1981 B {published data only}
  • As Busuttil 1981 A.
Chiam 1983 A {published data only}
  • Chiam HL, Chee CP, Cheah KC, Somasundaram K, Puthucheary SD. The prevention of postappendicectomy sepsis by metronidazole and cotrimoxazole: a controlled double blind trial. Aust Nz J Surg 1983;53(5):421-5.
Chiam 1983 B {published data only}
  • As Chiam 1983 A.
Chiam 1983 C {published data only}
  • As Chiam 1983 A.
Corbett 1979 {published data only}
  • Corbett R, Prout WG, Hewitt GW, Tuke W, Okubadejo OA. The value of metronidazole prophylaxis in appendectomy patients. Proc R Soc Med Int Congress and Symposium Series 1979;18:111-13.
Creve 1980 A {published data only}
Creve 1980 B {published data only}
  • As Creve 1980 A.
Donovan 1979 A {published data only}
Donovan 1979 B {published data only}
  • As Donovan 1979 A.
Eklund 1987 {published data only}
El-Sefi 1986 A {published data only}
  • el-Sefi TA, el-Awadi HM, Shehata MI, Al-Hindi MA. The place of antibiotics in the prevention of post-appendicectomy sepsis: a prospective study of 400 cases. Int Surg 1986;71(1):18-21.
El-Sefi 1986 B {published data only}
  • As el Sefi 1986 A.
El-Sefi 1986 C {published data only}
  • As el Sefi 1986 A.
Foster 1978 {published data only}
Foster 1981 A {published data only}
  • Foster GE, Bourke JB, Bolwell J, Doran J, Balfour TW, Holliday A, Hardcastle JD, Marshall DJ. Clinical and economic consequences of wound sepsis after appendicectomy and their modification by metronidazole or povidone iodine. Lancet 1981;1(8223):769-71.
Foster 1981 B {published data only}
  • As Foster 1981 A.
Giacomantonio 1982 {published data only}
  • Giacomantonio M, Bortolussi R, Gillis DA. Should prophylactic antibiotics be given perioperatively in acute appendicitis without perforation?. Can J Surg 1982;25(5):555.
Gledhill 1983 {published data only}
  • Gledhill T, Odurny A, Weaver PC. A controlled study of single dosage cefamandole in the prophylaxis of wound infections in appendectomy. Surg Gynaecol Obstetr 1983;156(3):295-7.
Go 1986 {published data only}
  • Go PM, Luyendijk R, Munting JD. [Metronidazole prophylaxis in appendectomy]. [Dutch] [Metronidazolprofylaxe bij appendectomie.]. Ned Tijdschr Geneeskd 1986;130(17):775-8.
Gottrup 1979 {published data only}
  • Gottrup F. Prophylactic metronidazole in prevention of infection after appendicectomy: report of a double-blind trial. Acta Chir Scand 1980;146(2):133-6.
  • Gottrup F, Sorensen I. [Infection after appendectomy. Effect of preventive metronidazole therapy]. [Danish] [Infektion efter appendektomi. Effekten af metronidazolprofylakse.]. Ugeskr Læger 1979;141(34):2293-6.
Greenall 1979 {published data only}
Griffiths 1976 {published data only}
Gurry 1976 {published data only}
Harnoss 1986 {published data only}
  • Harnoss BM, Raetzel G, Görtz G, Häring R, Hilgemann K, Hopfenmüller W. A prospective randomized study of antibiotic prophylaxis with metronidazole in appendicitis. Krankenhausartz 1986;59(8):589-93.
Hutchinson 1983 {published data only}
  • Hutchinson GH, Patel BG, Doig CM. A double-blind controlled trial of metronidazole suppositories in children undergoing appendicectomy. Current Medical Research & Opinion (England) 1983;8(6):441-5.
Keiser 1983 {published data only}
Kekomäki 1983 {published data only}
  • Kekomäki M, Louhimo I. [Metronidazole in appendectomy] [Finnish] [Metronidatsoli ja appendisektomia]. Suomen Löökörilehti 1983;38:353-57.
Kizilcan 1992 A {published data only}
Kizilcan 1992 B {published data only}
  • As Kizilcan 1992 A.
Kizilcan 1992 C {published data only}
  • As Kizilcan 1992 A.
Kortelainen 1982 {published data only}
  • Kortelainen P, Huttunen R, Kairaluoma MI, Mokka REM, Laitinen S, Larmi TKI. Single-dose intrarectal metronidazole prophylaxis against wound infection after appendectomy. Am J Surg 1982;143:244-45.
Leigh 1976 {published data only}
Morris 1980 A {published data only}
Morris 1980 B {published data only}
  • As Morris 1980 A.
Morris 1980 C {published data only}
  • As Morris 1980 A.
Paakkonen 1982 {published data only}
  • Paakkonen M, Mononen P, Kostiainen S. The value of a single intravenous dose of metronidazole as prophylaxis against wound infection after appendicectomy. Ann Chir Gynaecol 1982;71(2):137-9.
Raahave 1970 {published data only}
  • Raahave D, Poulsen PE. Perforated appendicitis and antibiotics. A survey and a controlled clinical trial. Acta Chir Scand 1970;136(8):715-23.
Richards 1981 {published data only}
  • Richards DG, Clark RG, Rowlands BJ, Moore PJ, Eyre-Brook I, Kay PH. Antibiotic prophylaxis against wound infection in emergency abdominal surgery. J Royal Coll Surg Edinb 1981;26(4):232-37.
Rodgers 1979 {published data only}
Rowlands 1982 {published data only}
Saario 1981 {published data only}
  • Saario I, Wuokko E, Saario L, Silvola H. Metronidazole prophylaxis against wound infection in patients undergoing appendicectomy. Ann Chir Gynaecol 1981;70(2):71-4.
Salo 1981 {published data only}
  • Salo J, Silvennoinen E, Hulkko A, Ervasti E, Holopainen O. Tinidazole in the prophylaxis of post-appendicectomy infections. Ann Chir Gynaecol 1981;70(4):187-90.
Sole 1982 {published data only}
  • Sole GM, Studley JGN, Powis SJA. Post-appendicectomy wound sepsis the prophylactic value of Metronidazole and Cefoxitin. Br J Clin Pract 1982;36(3):90-2.
Stoller 1965 {published data only}
  • Stoller JL. Topical antibiotic therapy in acute appendicitis. Br J Clin Practice 1965;19(12):687-8.
Söderquist 1995 A {published data only}
  • Söderquist-Elinder C, Hirsch K, Bergdahl S, Rutqvist J, Frenckner B. Prophylactic antibiotics in uncomplicated appendicitis during childhood - a prospective randomised study. Eur J Pediatr Surg 1995;5:282-285.
Söderquist 1995 B {published data only}
  • Söderquist-Elinder C, Hirsch K, Bergdahl S, Rutqvist J, Frenckner B. Prophylactic antibiotics in uncomplicated appendicitis during childhood - a prospective randomised study. Eur J Pediatr Surg 1995;5:282-285.
Tanner 1980 {published data only}
Viitanen 1984 A {published data only}
  • Viitanen J, Tunturi T, Auvinen O, Pessi T. Tinidazole prophylaxis in appendicectomies. A controlled study of single-dose versus 3-day therapy. Scand J Gastroenterol 1984;19(1):111-5.
Viitanen 1984 B {published data only}
  • As Viitanen 1984 A.
Wayand 1982 {published data only}
  • Wayand W, Trost A. Perioperative antibiotic prophylaxis with cefamandol before appendectomy: a prospective randomized double blind study. Fortschr Med 1982;100(5):190-4.
Willis 1976 {published data only}
  • Willis AT, Ferguson IR, Jones PH, Phillips KD, Tearle PV, Berry RB, Fiddian RV, Graham DF, Harland DH, Innes DB, Mee WM, Rothwell-Jackson RL, Sutch I, Kilbey C, Edwards D. Metronidazole in prevention and treatment of bacteroides infections after appendicectomy. Br Med J 1976;1(6005):318-21.
Winslow 1983 {published data only}

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Amgwerd 1981 {published data only}
  • Amgwerd R, Biegger P. Acute nonperforating appendicitis. Efficacy of brief antibiotic prophylaxis [Prospektive Studie zur Verhutung von Wundinfekten nach Appendektomie bei Appendicitis acuta]. Schweiz Med Wochenschr 1981;111(35):1269-73.
Andersen 1972 {published data only}
  • Andersen B, Bendtsen A, Holbraad L, Schantz A. Wound infections after appendicectomy. I. A controlled trial on the prophylactic efficacy of topical ampicillin in non-perforated appendicitis. II. A controlled trial on the prophylactic efficacy of delayed primary suture and topical ampicillin in perforated appendicitis. Acta Chir Scand 1972;38(5):531-6.
Badia 1994 {published data only}
  • Badia JM, Martinez-Rodenas F, Oms LM, Valverde J, Franch G, Rosales A, Serrano R, Sitges-Serra A. [Randomized prospective study on antibiotic prophylaxis compared with lavage of the surgical wound in unperforated appendicitis] [Spanish] [Estudio prospectivo aleatorizado de la profilaxis antibiotica comparada con el lavado de la herida quirurgica en apendicitis no perforada]. Med Clin (Barc) 1994;103(6):201-4.
Bates 1974 {published data only}
Birkigt 1989 {published data only}
  • Birkigt HG, Beyer H, Schmidt U. [Preventive use of single dose antibiotics in acute appendicitis. Results of a prospective randomized clinical study]. [German] [Single-dose-Antibiotikaprophylaxe bei akuter Appendizitis. Ergebnisse einer prospektiven randomisierten klinischen Studie.]. Zentralbl Chir 1989;114(20):1348-54.
Birkigt 1991 {published data only}
  • Birkigt HG, Beyer H. [General or individually calculated preventive antibiotic administration. Summary of the Magdeburg appendicitis study]. [German] [Generelle oder individuell kalkulierte Antibiotikaprophylaxe. Rusumee der Magdeburger Appendizitisstudie]. Zentralbl Chir 1991;116(13):795-800.
Bröte 1976 {published data only}
Calman 1971 {published data only}
Crosfill 1969 {published data only}
Dixon 1984 {published data only}
  • Dixon JM, Armstrong CP, Duffy SW, Chetty U, Davies GC. A randomized prospective trial comparing the value of intravenous and preincisional cefamandole in reducing postoperative sepsis after operations upon the gastrointestinal tract.. Surg Gynaecol Obstet 1984;158(4):303-7.
Evans 1973 {published data only}
Everson 1977 {published data only}
Feltis 1967 {published data only}
  • Feltis JM jr, Hamit HF. Use of prophylactic antimicrobial drugs to prevent postoperative wound infections. Am J Surg 1967;114(6):867-70.
Gilmore 1973 {published data only}
Gilmore 1975 {published data only}
Gómez-Alonso 1984 {published data only}
  • Gomez-Alonso A, Lozano F, Perez A, Almazan A, Abdel-lah A, Cuadrado F. Systemic prophylaxis with gentamicin-metronidazole in appendicectomy and colorectal surgery: a prospective controlled clinical study. Int Surg 1984;69(1):17-20.
Harahsheh 2002 {published data only}
  • Harahsheh B, Hiyasat B, Abulail A, Al-Basheer M. Management of wound infection after appendectomy: are parenteral antibiotics useful?. East Mediterr Health J 2002;8(4-5):638-44. [MEDLINE: 15603047]
Herrera-Garcia 1985 {published data only}
  • Herrera-Garcia A, Dibildox M, Albarran Trevino C. [Efficacy of a single intravenous dose of antimicrobials in prevention against post-appendectomy wound infection: a blind comparative study of metronidazole, clindamycin and a placebo] [Spanish]. Rev Gastroenterol Mex. 1985;50(1):41-5.
Kling 1985 {published data only}
  • Kling PA, Holmlund D, Burman LG. Prevention of post-operative infection in appendicectomy by single dose intravenous metronidazole. Acta Chir Scand 1985;151(1):73-6.
Leigh 1978 {published data only}
Marti 1978 {published data only}
  • Marti MC, Moser G. [Prevention of parietal septic complications by irrigation of the surgical wound]. [French] [Prevention des complications septiques parietales par irrigation de la plaie operatoire]. Helv Chir Acta 1979;45(6):739-42.
McGreal 2002 {published data only}
  • McGreal GT, Joy A, Manning B, Kelly JL, O'Donell JA, Kirwan WW, Redmond HP. Antiseptic wick: does it reduce the incidence of wound infection following appendectomy?. World J Surg 2002;26(5):631-4. [MEDLINE: 12098059]
McLean 1983 {published data only}
  • McLean MD, Buick RG, Boston VE. The influence of metronidazole prophylaxis and the method of closure on wound infection in non-perforating appendicitis in childhood. Z Kinderchir 1983;38:283-5.
Okubadejo 1976 {published data only}
  • Okubadejo DA, Peet TND, Turner DTL. Clindamycin prophylaxis in appendectomy wound infections. Chemotherapy 1976;1:287-93.
Pietila 1982 {published data only}
  • Pietila J, Jauhiainen K, Davidsson L. [Metronidazole prophylaxis in excision of the appendix]. [Finnish] [Metronidatsoliprofylaksi umpilisakkeen poiston yhteydessa.]. Duodecim 1982;98(4):267-71.
Pollock 1972 {published data only}
Rambo 1972 {published data only}
Tanphiphat 1978 {published data only}
Taylor 2000 {published data only}
  • Taylor E, Dev V, Shah D, Festekjian J, Gaw F. Complicated appendicitis: is there a minimum intravenous antibiotic requirements? A prospective randomized trial.. Am Surg 2000;66:887-90. [MEDLINE: 10993623]
Taylor 2004 {published data only}
  • Taylor E, Berjis A, Bosch T, Hoehne F, Ozaeta M. The efficacy of postoperative oral antibiotics in appendicitis: a randomized prospective double-blinded study.. Am Surg 2004;70(10):858-62. [MEDLINE: 15529837]
Walsh 1981 {published data only}
Willis 1979 {published data only}
  • Willis AT. Metronidazole in the prevention and treatment of anaerobic sepsis. Scandinavian Journal of Infectious Diseases - Supplement 1979;19:98-104.

References to studies awaiting assessment

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Simpson 2002 {published data only}
  • Simpson ET, Corbett H. Antibiotic use in appendicitis [abstract]. ANZ Journal of Surgery 2002;72 Suppl:A72.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Addiss 1990
Almqvist 1995
Altemeier 1938
  • Altemeier WA. The bacterial flora of acute perforated appendicitis with peritonitis. Ann Surg 1938;107:517-528.
Arnbjörnsson 1983
Bennion 1990
  • Bennion RS, Thompson JE, Baron EJ, Finegold SM. Gangrenous and perforated appendicitis with peritonitis: treatment and bacteriology. Clin Ther 1990;12(suppl. c):31-44.
Blewett 1995
  • Blewett JC, Krummel TM. Perforated appendicitis: Past and future controversies. Seminars in Pediatric Surgery 1995;4(4):234-38.
Fenyö 1995
  • Fenyö G. [Appendectomy in Sweden] [Swedish] [Appendektomi i Sverige]. Nord Med 1995;110:11-113.
Graffeo 1996
  • Graffeo CS, Counselmann FL. Appendicitis. Emergency Medicine Clinics of North America 1996;14(4):653-.
Jadad 1996
  • Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Cavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Controlled Clinical Trials 1996;17(1):1-12.
Leigh 1974
Luckmann 1989