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[Inappropriate use of antibiotics in acute appendicitis. A survey of Mexican surgeons]
José Francisco Corona-Cruz1, Javier Melchor-Ruan, Noé Isaías Gracida-Mancilla
1Servicio de Cirugía General, Hospital General de México, México D.F., Mexico. jofran_77@hotmail.com
Background:
Appendectomy is the most common non-elective surgery. The postoperative use of antibiotics depends on the stage of the appendix at the time of surgery. Several classifications establish that state. We determine if these classifications are known and used by Mexican surgeons.
Methods:
A descriptive and observational study was performed. A questionnaire was completed by surgeons asking the following questions: Do you use a classification for acute appendicitis? 2) Which classification do you prefer? 3) Do you use antibiotics postoperatively? 4) For what period of time do you administer antibiotics postoperatively? We evaluated if the postoperative treatment is influenced by the use of a classification, using the chi(2) test.
Results:
One hundred and forty two surgeons were interviewed, 99% used a classification, and 48% indicated postoperative antibiotics, despite the stage of the disease, monotherapy (69%), and for three doses (60%). Fifty two percent used antibiotic only in advanced stages, with two different types (61%), and from 7 to 10 days (66%). We did not find any statistical difference in management, regardless of whether or not an appendicitis classification was used.
Conclusions:
Although most surgeons use one classification for acute appendicitis, this does not influence postoperative treatment. This incongruity results in the unjustified use of antibiotics.
Insights
Most surgeons use appendicitis classifications, but this doesn't impact antibiotic use. This leads to unnecessary antibiotic prescriptions, highlighting a gap in surgical practice for appendectomy patients.
Area of Science:
- Surgical Practice
- Infectious Disease Management
Context:
- Appendectomy is the most frequent emergency surgery.
- Postoperative antibiotic use is guided by appendicitis staging, with various classification systems available.
- The study investigates awareness and application of these classifications among Mexican surgeons.
Purpose:
- To determine if Mexican surgeons utilize appendicitis staging classifications.
- To assess the influence of these classifications on postoperative antibiotic prescribing habits.
Summary:
- A survey of 142 surgeons revealed 99% use a classification system for acute appendicitis.
- However, 48% prescribed postoperative antibiotics irrespective of disease stage, with common durations of three doses.
- No statistically significant association was found between using a classification and antibiotic treatment decisions.
Impact:
- Despite widespread use of appendicitis classifications, their application does not correlate with postoperative antibiotic management.
- This disconnect results in the unwarranted administration of antibiotics, potentially contributing to antibiotic resistance.
- Findings suggest a need for better integration of staging classifications into clinical decision-making for appendectomy patients.
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