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Antibiotics versus placebo for prevention of postoperative infection after appendicectomy.

  1. BR Andersen Clinician*,
  2. FL Kallehave,
  3. HK Andersen Clinician*

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 22 APR 2003

DOI: 10.1002/14651858.CD001439

How to Cite

Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy.. The Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD001439. DOI: 10.1002/14651858.CD001439.

Author Information

  1. H:S Bispebjerg Hospital, Department of Surgical Gastroenterology K, Copenhagen NV, DENMARK

*BR Andersen, Clinician, Department of Surgical Gastroenterology K, H:S Bispebjerg Hospital, 23 Bispebjerg Bakke, Copenhagen NV, DK 2400, DENMARK. cccg@cccg.dk.HK Andersen, Clinician, Department of Surgical Gastroenterology K, H:S Bispebjerg Hospital, 23 Bispebjerg Bakke, Copenhagen NV, DK 2400, DENMARK. cccg@cccg.dk.

Publication History

  1. Published Online: 22 APR 2003

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Abstract

  1. Top of page
  2. Abstract
  3. Synopsis

Background

Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. The cause of appendicitis is unclear and the mechanism of pathogenesis continues to be debated. Despite improved asepsis and surgical techniques, postoperative complications, such as wound infection and intraabdominal abscess, still account for a significant morbidity. Several studies implicate that postoperative infections are reduced by administration of antimicrobial regimes.

Objectives

The objective of this review is to evaluate the use of antibiotics with placebo or no treatment in patients undergoing appendectomy. Will these patients benefit from antimicrobial prophylaxis? The outcomes are described according to the nature of the appendix, as either simple appendicitis (including the non-infectious stage) and complicated appendicitis. This review do not attempt to compare the effect of different regimens. That clinical question is addressed in another review undertaken by Bleuer 1999.

Search strategy

We searched The Cochrane Controlled Trials Register (Cochrane Library 2002 issue 4); Pubmed , Embase and the Cochrane Colorectal Cancer Group Specialised Register (Up to October 2002). In addition we manually searched the reference lists of the primary identified trials.

Selection criteria

We evaluated Randomised Controlled Trials (RCTs) and Controlled Clinical Trials (CCTs) in which any antibiotic regime were compared to placebo in patients suspected of having appendicitis, and undergoing appendectomy. Both studies on children and adults were reviewed. The outcome measures of the studies were: Wound infection, intra abdominal abscess, length of stay in hospital, and mortality.

Data collection and analysis

Eligibility and trial quality were assessed, recorded and cross-checked by two reviewers.

Main results

Forty-five studies including 9576 patients were included in this review. The overall result is that the use of antibiotics is superior to placebo for preventing wound infection and intraabdominal abscess, with no apparant difference in the nature of the removed appendix. Studies exclusively on children and studies examining topical application reported results in favour to the above although the results were not significant.

Authors' conclusions

Antibiotic prophylaxis is effective in the prevention of postoperative complications in appendectomised patients, whether the administration is given pre-, peri- or post-operatively, and could be considered for routine in emergency appendectomies.

 

Synopsis

  1. Top of page
  2. Abstract
  3. Synopsis

Synopsis

Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. On suspicion of acute appendicitis the standard procedure is surgery. This is associated with increased risk of postoperative complications, wound infection being the most commonly reported. Standard prophylaxis is an anti-bacterial treatment. In order to reduce cost, toxicity and the risk of developing bacterial resistance, it is desirable to establish the shortest and most effective prophylaxis for postoperative complications.
From this study, antibiotic prophylaxis is effective in the prevention of postoperative complications in people who had the appendix removed. Regardless whether the antibiotic was given before, under or after the surgery. Consequently, antibiotic prophylaxis could be considered for routine in emergency appendectomies.