Related Experiment Videos
A comparison between imipenem and metronidazole prophylaxis against sepsis following appendicectomy
D S Burkitt1, I A Donovan, R Wise
1Department of Surgery, Dudley Road Hospital, Birmingham, UK.
Abstract:
A single preoperative dose of imipenem/cilastatin was compared with metronidazole for the prevention of infectious sequelae following emergency appendicectomy. Patients with established sepsis received in addition 72 h of either intravenous imipenem or ampicillin, gentamicin and metronidazole postoperatively. Two hundred and sixty-eight patients were studied. Wound infection rate in low-risk patients was 9% for metronidazole and 8% for imipenem. When sepsis was already established intraperitoneally the wound infection rate was 24% for the triple therapy regimen and 8% for imipenem. There was no statistically significant difference between the infection rates in the two groups of treatment whatever the state of the appendix, but there was a trend in favour of imipenem in those patients with a perforated appendix.
Insights
A study compared imipenem/cilastatin with metronidazole for preventing infections after emergency appendicectomy. Imipenem showed a trend towards lower wound infection rates, especially in perforated appendix cases.
Area of Science:
- Surgical Infectious Diseases
- Antimicrobial Prophylaxis
- Emergency Medicine
Background:
- Infectious sequelae are a concern following emergency appendicectomy.
- Antibiotic prophylaxis is crucial in preventing surgical site infections.
- Comparing broad-spectrum antibiotics with traditional agents is important for optimizing treatment.
Purpose of the Study:
- To compare the efficacy of a single preoperative dose of imipenem/cilastatin versus metronidazole in preventing infectious complications after emergency appendicectomy.
- To evaluate the impact of these prophylactic regimens in patients with and without established intraperitoneal sepsis.
Main Methods:
- A randomized study involving 268 patients undergoing emergency appendicectomy.
- Group 1 received a single preoperative dose of imipenem/cilastatin.
- Group 2 received a single preoperative dose of metronidazole. Patients with established sepsis received additional 72-hour intravenous antibiotics (imipenem or ampicillin, gentamicin, and metronidazole).
Main Results:
- Low-risk patients: Wound infection rate was 8% for imipenem/cilastatin versus 9% for metronidazole.
- Patients with established intraperitoneal sepsis: Wound infection rate was 8% for imipenem/cilastatin versus 24% for the triple therapy regimen (ampicillin, gentamicin, metronidazole).
- A trend favoring imipenem/cilastatin was observed in patients with perforated appendices, though not statistically significant.
Conclusions:
- A single preoperative dose of imipenem/cilastatin appears effective in preventing infectious sequelae after emergency appendicectomy.
- Imipenem/cilastatin demonstrated superior efficacy compared to metronidazole and triple therapy in patients with established intraperitoneal sepsis.
- Further investigation into imipenem/cilastatin for perforated appendix cases is warranted.