A single prophylactic antibiotic for emergency appendicectomy?

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.