Cefotaxime lavage in children undergoing appendicectomy.

Area of Science:

• Surgical Infection Prevention
• Antimicrobial Prophylaxis
• Clinical Trials

Background:

• Postoperative sepsis remains a significant concern in surgical practice.
• Previous studies established cefotaxime and metronidazole as effective backbone therapy for reducing surgical site infections.
• Optimizing prophylactic regimens is crucial for improving patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of adding peritoneal lavage with cefotaxime to standard antibiotic prophylaxis in reducing postoperative sepsis.
• To compare infection rates between patients receiving standard prophylaxis versus those receiving additional peritoneal lavage.
• To analyze outcomes in different appendicitis severity classifications.

Main Methods:

• A randomized, double-blind study (Stage III) involving 401 patients undergoing surgery.
• Group 1: Standard cefotaxime and metronidazole prophylaxis (pre- or peroperative).
• Group 2: Standard prophylaxis plus intraoperative peritoneal lavage with cefotaxime (2 g/L).

Main Results:

• Overall wound infections: 16 cases (2 preop, 14 perop prophylaxis).
• Postoperative sepsis rates: 5.6% (non-lavage) vs. 4.3% (lavage group).
• In perforated/gangrenous appendicitis, wound infection rates were 11.1% (non-lavage) vs. 6.1% (lavage group).

Conclusions:

• Adding peritoneal lavage with cefotaxime demonstrated a potential benefit in reducing postoperative sepsis, particularly in complicated appendicitis.
• Standard cefotaxime and metronidazole prophylaxis is effective, but adjunctive lavage may offer further improvement.
• Further research may be warranted to confirm the benefits of intraoperative peritoneal lavage in specific surgical contexts.