Effect of post operation antibiotic on infectious complication of suppurative appendicitis

Abdoulhossein Davoodabadi, Esmail Kashi, Hamid Pourvali, Hossein Akbari


The most common complication of suppurative appendicitis is surgical wound infection and prophylactic antibiotics being used to prevent it. This study evaluates the relationship between postoperative antibiotics and wound infection rate and intra-abdominal infectious complications after suppurative stage appendectomy. This study was a single-blind randomized clinical trial. The population consisted of patients ageing 18-50 years old, admitted to Kashan Shahid Beheshti General Hospital from November 2013, to May, 2016 with the diagnosis of acute suppurative appendicitis. To achieve uniformity in operative procedure, a standard operative protocol was applied. After the operation, patients in group A received 1 gram ceftriaxone every 12 hours plus 500 mg metranidazol intravenously during hospitalization and 3 days after discharge, orally and patients in group B received no antibiotics after operation.Using the SPSS-18 statistical software, the collected data were analyzed. In all statistical tests a p < 0.05 was considered statistically significant. Of 140 patients, 90 (64%) were men and 50 (36%) were female and the mean age was the 29.03 ± 10.21 years. The mean operative times was 60 ± 10 min and the mean hospital stay were 48 ± 4 and 48 ± 6 hour in A and B groups respectively. This study showed that the incidence of surgical site infection and intra-abdominal abscess in both group was similar and also the temperature, white blood cell count and polymorphonuclear cells in the two groups were similar. The incidence of infectious complication in patients who had not received postoperative antibiotics was similar to the group that received antibiotics thus indicating no need for any additive postoperative antibiotics.


Appendicitis, postoperative antibiotics, suppurative appendicitis

Full Text:



Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev 3:CD001439, 2005.

Bauer T et al. Antibiotic prophylaxis in acute nonperforated appendicitis. The Danish Multicenter Study Group III. Ann Surg 209:307-311, 1989.

Mehrabi Bahar M, Jangjoo A, Amouzeshi A, Kavianifar K. Wound infection incidence in patients with simple and gangrenous or perforated appendicitis. Arch Iran Med 13:13-16, 2010.

Hussain MI, Alam MK, Al-Qahatani HH, Al-Akeely MH. Role of postoperative antibiotics after appendectomy in non-perforated appendicitis. J Coll Physicians Surg Pak 22:756-759, 2012.

Fraser JD et al. A complete course of intravenous antibiotics vs a combination of intravenous and oral antibiotics for perforated appendicitis in children: a prospective, randomized trial. J Pediatr Surg 45:1198-1202, 2010.

Suh YJ et al. Comparison of surgical-site infection between open and laparoscopic appendectomy. J Korean Surg Soc 82:35-39, 2012.

Le D, et al. Post-operative antibiotic use in nonperforated appendicitis. Am J Surg, 2009. 198:748-52.

Ravari H, et al. Oral metronidazole as antibiotic prophylaxis for patients with nonperforated appendicitis. Clin Exp Gastroenterol, 2011. 4:273-6.

Kimbrell AR, et al. Do postoperative antibiotics prevent abscess formation in complicated appendicitis? Am Surg, 2014. 80:878-83.

Coakley BA, et al. Postoperative antibiotics correlate with worse outcomes after appendectomy for nonperforated appendicitis. J Am Coll Surg, 2011. 213:778-83.

Paul M, et al. Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother 54:4851-63, 2010.

Ohle, R., et al., The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med 9:139, 2011.

Donovan IA, et al. One-dose antibiotic prophylaxis against wound infection after appendicectomy: a randomized trial of clindamycin, cefazolin sodium and a placebo. Br J Surg 66(3):193-196, 1979.

Foster PD, O'Toole RD. Primary appendectomy. The effect of prophylatic cephaloridine on postoperative wound infection. JAMA 239:1411-1412, 1978.

Mui LM, et al. Optimum duration of prophylactic antibiotics in acute non-perforated appendicitis. ANZ J Surg 75:425-428, 2005.

Ein SH, Sandler A. Wound infection prophylaxis in pediatric acute appendicitis: a 26-year prospective study. J Pediatr Surg 41:538-541, 2006.

Foster GE, et al. Clinical and economic consequences of wound sepsis after appendicectomy and their modification by metronidazole or povidone iodine. Lancet 1:769-771, 1981.

Gorecki WJ, Grochowski, JA. Are antibiotics necessary in nonperforated appendicitis in children? A double blind randomized controlled trial. Med Sci Monit, 7:289-292, 2001.

Nadler EP, Gaines BA. The Surgical Infection Society guidelines on antimicrobial therapy for children with appendicitis. Surg Infect (Larchmt) 9:75-83, 2008.

Rafiq MS, et al. Evaluation of postoperative antibiotics after non-perforated appendectomy. J Pak Med Assoc 65:815-817, 2015.

Liberman MA, et al. Single-dose cefotetan or cefoxitin versus multiple-dose cefoxitin as prophylaxis in patients undergoing appendectomy for acute nonperforated appendicitis. J Am Coll Surg 180:77-80, 1995.

Jaffe BM, BD. The appendix. Schwartz's Principles of Surgery. Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE, ed. -. 9. Vol. 9th edition. 2010, New York: McGraw-Hill.

Lau WY, et al. Randomized, prospective, and double-blind trial of new beta-lactams in the treatment of appendicitis. Antimicrob Agents Chemother, 1985. 28(5): p. 639-642, 1985.

Hale DA, et al. Appendectomy: a contemporary appraisal. Ann Surg, 1997. 225(3): p. 252-61.

Zerem, E., et al., Comparison of therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of periappendiceal abscess: is appendectomy always necessary after perforation of appendix? Surg Endosc, 2007. 21(3): p. 461-6.

Kasatpibal N, et al. Risk of surgical site infection and efficacy of antibiotic prophylaxis: a cohort study of appendectomy patients in Thailand. BMC Infect Dis 6:111, 2006.


  • There are currently no refbacks.

Best Quality Medical Supplies is a registered company in Untied States specializing in sales of medical equipment and supplies. We are a distributor for hospitals, doctor offices, medical clinics, nursing schools, and nursing homes within
the United States. We also provide services for overseas clients. Click here for details and orders.

My website has truly excellent support, going well beyond what's expected from the customer. Check them out here.