Related Experiment Videos
A single prophylactic antibiotic for emergency appendicectomy?
M el-Mufti1, F Rakas, A Glessa
1Department of General Surgery, Benghazi, Libya.
Insights
Ceftriaxone, a single-dose antibiotic, proved as effective as a multi-drug regimen for appendicectomy prophylaxis. This approach reduces nursing workload and costs, making it a viable option for emergency appendicectomy patients.
Area of Science:
- Surgical Infectious Diseases
- Pharmacology
- Clinical Microbiology
Background:
- Antibiotic prophylaxis is crucial in preventing surgical site infections following appendicectomy.
- Current standard regimens often involve multiple-drug combinations administered over several days.
- Optimizing antibiotic prophylaxis can improve patient outcomes and reduce healthcare costs.
Purpose of the Study:
- To compare the efficacy and economic impact of single-dose ceftriaxone versus a triple-antibiotic regimen for prophylaxis in emergency appendicectomy.
- To evaluate clinical outcomes including wound infection rates, post-operative fever, and hospital stay duration.
- To assess the impact on nursing resources and financial costs.
Main Methods:
- Prospective randomized study involving 200 patients over 12 years undergoing emergency appendicectomy.
- Comparison between single pre-operative dose of ceftriaxone (2g) and a routine triple regimen (metronidazole, gentamicin, ampicillin).
- Treatment duration varied based on appendicitis severity (perforation vs. non-perforation).
Main Results:
- Ceftriaxone group showed comparable or slightly better outcomes than the triple-regimen group.
- Wound infection rates were 3% for ceftriaxone vs. 5% for the triple regimen.
- Average hospital stay was shorter with ceftriaxone (4.5 days) compared to the triple regimen (5.9 days).
Conclusions:
- Single-dose ceftriaxone is clinically effective and potentially superior to the traditional triple-antibiotic regimen for appendicectomy prophylaxis.
- Ceftriaxone significantly reduces nursing effort and daily financial costs.
- The findings support the adoption of ceftriaxone for routine prophylactic use in emergency appendicectomy.
Abstract:
This paper reports the results of a prospective randomized study of antibiotic prophylaxis in 200 patients over the age of 12 years undergoing emergency appendicectomy at Al-Jala Hospital for Trauma and Emergency Surgery, Benghazi. We have compared the efficacy of ceftriaxone, a long-acting broad-spectrum cephalosporin with that of our routine regimen consisting of metronidazole, gentamicin and ampicillin, given together. Ceftriaxone was administered as a single pre-operative dose of 2 g (to be continued as a daily injection for 5 days in patients with perforated appendicitis). The triple combination was given on an 8-hourly basis for 3 days, extended to 5-7 days in cases of perforation. Patients receiving ceftriaxone did as well as or slightly better than those on the triple-antimicrobial regimen, in terms of wound infection rate (3 vs. 5%), incidence of transient post-operative pyrexia and duration of hospital stay (on average 4.5 vs. 5.9 days). More importantly, administering ceftriaxone as 1 injection per day led to a dramatic saving in terms of nursing effort and time (1 injection instead of 9 per 24 h) and of the daily financial cost of therapy per patient. It is concluded that the clinical results and economic implications seem to justify the use of ceftriaxone as a routine prophylactic antibiotic for patients undergoing emergency appendicectomy.