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Combined topical and systemic antibiotic prophylaxis in acute appendicitis
J L Seco1, E Ojeda, C Reguilon
1Department of General Surgery, Hospital General Yagë, Burgos, Spain.
American Journal of Surgery
|February 1, 1990
Summary
Combined antibiotic prophylaxis significantly reduced surgical wound infections after appendectomy. Topical ampicillin with systemic clindamycin proved more effective than clindamycin alone, especially in severe appendicitis cases.
Area of Science:
- Surgical Infectious Diseases
- Clinical Microbiology
Background:
- Surgical site infections (SSIs) are a significant complication following appendectomy.
- Optimizing antibiotic prophylaxis is crucial to reduce SSI rates, particularly in emergency settings.
Purpose of the Study:
- To evaluate the efficacy of combined systemic clindamycin and topical ampicillin versus systemic clindamycin alone in preventing wound infections after emergency appendectomy.
Main Methods:
- A randomized controlled trial involving 246 patients with acute appendicitis.
- Group 1 (120 patients): received preoperative systemic clindamycin.
- Group 2 (126 patients): received systemic clindamycin plus topical ampicillin solution applied to subcutaneous tissues.
Main Results:
- The combined prophylaxis group showed a significantly lower wound infection rate (4%) compared to clindamycin alone (p < 0.02).
- This reduction was most pronounced in patients with advanced appendicitis (gangrenous/perforated) (p < 0.05).
- A significant decrease in wound infections was also observed in patients with positive intraoperative cultures.
Conclusions:
- Combined systemic clindamycin and topical ampicillin is a more effective prophylactic strategy against wound infections post-appendectomy than clindamycin alone.
- This combination therapy is particularly beneficial for patients with severe appendicitis and significant wound contamination.