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Metronidazole and Augmentin in the prevention of sepsis after appendicectomy
Abstract:
Two hundred and fifty patients were admitted to a prospective randomized trial to compare the efficacy of Augmentin with metronidazole in the prevention of sepsis after appendicectomy. Pre-operatively they received either 500 mg metronidazole or 1.2g Augmentin intravenously. Those patients with gangrenous or perforated appendices received eight additional doses of the trial drug at 8 hourly intervals. Overall there were 13 wound infections in the Augmentin group (11 per cent) and 21 in the metronidazole group (18 per cent). The 90 per cent confidence limits for the overall 7 per cent difference in infection rates were +/- 8.5 per cent. There were high rates of wound infection in the gangrenous group (Augmentin 8 per cent versus metronidazole 19 per cent) and especially in the perforated group (Augmentin 33 per cent versus metronidazole 63 per cent). There was no statistically significant difference between the infection rates with the two antibiotics but our study suggests that Augmentin, which is active against both aerobes and anaerobes, may be more effective than metronidazole in reducing wound sepsis after appendicectomy.
Insights
This study compared Augmentin and metronidazole for preventing sepsis after appendicectomy. While not statistically significant, Augmentin showed a trend towards lower wound infection rates, especially in severe cases.
Area of Science:
- Surgical Infection Prevention
- Clinical Pharmacology
- Microbiology
Background:
- Sepsis following appendicectomy remains a significant clinical concern.
- Antibiotic prophylaxis is standard practice to reduce post-operative infections.
- Comparing the efficacy of different antibiotic regimens is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the efficacy of Augmentin versus metronidazole in preventing surgical site infections (SSIs) after appendicectomy.
- To evaluate antibiotic effectiveness in patients with uncomplicated, gangrenous, or perforated appendices.
- To assess the impact of antibiotic choice on overall sepsis rates post-appendicectomy.
Main Methods:
- A prospective randomized trial involving 250 patients undergoing appendicectomy.
- Pre-operative intravenous administration of either Augmentin (1.2g) or metronidazole (500mg).
- Extended antibiotic dosing for patients with gangrenous or perforated appendices.
Main Results:
- Overall wound infection rates were 11% for Augmentin and 18% for metronidazole.
- Higher infection rates were observed in patients with gangrenous (Augmentin 8%, metronidazole 19%) and perforated appendices (Augmentin 33%, metronidazole 63%).
- No statistically significant difference in infection rates between the two antibiotic groups was found.
Conclusions:
- Augmentin may offer a potential advantage over metronidazole in reducing wound sepsis post-appendicectomy, particularly in complicated cases.
- The broad-spectrum activity of Augmentin against aerobes and anaerobes could contribute to its observed trend.
- Further research with larger sample sizes may be warranted to confirm the statistical significance of these findings.