Cefoxitin versus gentamicin and metronidazole in prevention of post-appendicectomy sepsis: a randomized, prospective...

Three hundred and seven patients with appendicitis were randomized to receive cefoxitin or gentamicin and metronidazole. For early appendicitis, a single preoperative dose of antibiotics was given. For late cases, the antibiotics were continued postoperatively for seven days. Both cefoxitin and gentamicin-metronidazole were effective in the reduction of post-appendicectomy septic complications in early or late appendicitis and there was no statistically significant difference between them. Mild transient and reversible nephrotoxicity was detected in 1.9% of patients who received gentamicin-metronidazole for seven days. Nephrotoxicity was not detected in any other patients. The cost of cefoxitin is higher, but this has to be balanced against the costs of monitoring serum gentamicin and creatinine levels, and the need to adjust the gentamicin dosage in 19% of patients when gentamicin-metronidazole was used. Both cefoxitin and gentamicin-metronidazole are effective and safe when used carefully. Cefoxitin has a slight advantage in its lack of potential nephrotoxicity and ototoxicity.