The prevention of postappendicectomy sepsis by metronidazole and cotrimoxazole: a controlled double blind trial

A double-blind, randomized controlled trial was carried out in University Hospital, Kuala Lumpur to study the effect of metronidazole and cotrimoxazole on the incidence of wound infection following appendicectomy from November 1978 to January 1980. Patients were allocated at random into one of four groups: cotrimoxazole injection and placebo suppository, metronidazole suppository and cotrimoxazole injection, metronidazole suppository and placebo injection or placebo suppository and placebo injection. Treatment was started 30 min before operation and continued for 72h. All patients were followed up for 2 weeks and thereafter for one month. A total of 283 patients was finally accepted into the study. Sepsis rates were found to be 27% for the untreated group, 9% for the group receiving metronidazole only, 8% for the group receiving cotrimoxazole injection only and 2.7% for the group receiving both drugs. The study showed that a combination of metronidazole and cotrimoxazole is a regime highly effective for prophylaxis against wound infection following appendicectomy.