Brief communication (Original). Optimum duration of perioperative antibiotic therapy in patients with acute non-perforated appendicitis: a prospective randomized trial

Background: Inappropriate use of antibiotics for perioperative antimicrobial therapy can cause considerable complications including emergence of antibiotic resistance, risk of drug reactions and economic implications.

Objective: We assessed the use of antibiotics in patients with acute non-perforated appendicitis.

Methods: The study was performed on 317 patients aged 15 to 70 years with non-perforated appendicitis who were undergoing open appendectomy. All patients received intravenous ceftriaxone (1 g) and metronidazole (500 mg) immediately after appendectomy. Patients were randomized into one of the following three treatment protocols; A: no further antibiotics, B: three more doses of antibiotics for 1 day (ceftriaxone 1 g every 12 hours and metronidazole 500 mg every 8 hours), or C: a 3-day course of antibiotics (ceftriaxone 1 g every 12 hours and metronidazole 500 mg every 8 hours) as the postoperative antibiotic regimen. Postoperative infective complication was the primary endpoint within the 10-day postoperative follow-up period.

Results: A total of 291 patients (female 37.5%), were subjected to final analysis. This included 97 patients in each group. Twenty-six patients failed to return for wound assessment. The groups were comparable in baseline characteristics including age and gender. The Overall frequency of surgical site infection was 6.25%, with 8.2% in group A, 6.25% in group B and 5.2% in group C. The rate of postoperative surgical infection was not significantly different among all groups. There were no perioperative mortalities. No untreated control group could be included for ethical reasons.

Conclusion: A combined preoperative single dose of metronidazole and ceftriaxone appears to be sufficient for the prevention of surgical site infections in patients with uncomplicated appendicitis.