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Nonperforative appendicitis: a continuing surgical dilemma
W Browder1, J W Smith, L M Vivoda
1Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
Abstract:
Acute appendicitis continues as a medical challenge with newer approaches failing to improve diagnostic accuracy. The role of antibiotics in acute nonperforative appendicitis (NPA) remains unclear. In 175 patients studied at two hospitals, preoperative guidelines were used to exclude perforative appendicitis. Nevertheless, 14% of patients were found to have this condition. Surgeon's reports significantly underestimated the diagnosis when compared with the pathologists' reports. Antibiotic prophylaxis in 122 patients with NPA was studied prospectively comparing ceftizoxime (CTZ), cefamandole (CFM), and placebo (PLA). Ceftizoxime decreased the infection rate compared with PLA (0 vs. 8; P less than .01). Use of antibiotics (CTZ or CFM) resulted in decreased infections when compared with PLA (3 vs. 8; P less than .01) and fewer days of hospitalization (3.8 vs. 5.4 d, P less than .005). Analysis of infection risk factors showed no correlations except for failure to administer antibiotics and the finding of a gangrenous appendix. Operative culture results had no predictive value for either infection or pathogen identification. It is recommended that all patients undergoing surgery for NPA be given 1 d of antibiotic prophylaxis.
Insights
Administering a single day of antibiotic prophylaxis to patients undergoing surgery for acute nonperforative appendicitis (NPA) significantly reduces infection rates and hospitalization duration. This practice is recommended for all patients with NPA.
Area of Science:
- Surgery
- Infectious Diseases
- Clinical Medicine
Background:
- Acute appendicitis remains a diagnostic challenge, with current methods lacking improved accuracy.
- The efficacy of antibiotics for acute nonperforative appendicitis (NPA) is not well-established.
Purpose of the Study:
- To evaluate the effectiveness of antibiotic prophylaxis in patients with acute nonperforative appendicitis (NPA).
Main Methods:
- A prospective study involving 122 patients with NPA compared ceftizoxime (CTZ), cefamandole (CFM), and placebo (PLA).
- Preoperative guidelines were used to exclude perforative appendicitis in 175 patients.
- Surgeon and pathologist diagnoses were compared.
Main Results:
- Ceftizoxime significantly reduced infection rates compared to placebo (0% vs. 8%, P < .01).
- Antibiotic use (CTZ or CFM) decreased infections (3% vs. 8%, P < .01) and hospitalization days (3.8 vs. 5.4 days, P < .005) versus placebo.
- Failure to administer antibiotics and gangrenous appendix were linked to infection risk.
Conclusions:
- One day of antibiotic prophylaxis is recommended for all patients undergoing surgery for NPA.
- Antibiotic prophylaxis effectively reduces postoperative infections and shortens hospital stays in NPA patients.