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The role of nitroimidazole derivates in bacterial infections-metronidazole prophylaxis in appendectomy
Abstract:
The commonest complication of appendicetomy is surgical sepsis, the incidence of which may vary from 4% for normal appendices to 77% for gangrenous or perforated appendices. Although some of these infections are relatively trivial others are serious or even life-threatening. In an effort to reduce the incidence of serious sepsis surgeons have used a variety of topical and systemic prophylactic antibacterial agents such as penicillin, ampicillin, tetracycline, lincomycin, tobramycin, cephalosporins, neomycin, bacitracin, polymyxin and povidone iodine. Although none of these prophylactic procedures has been consistently effective, appropriate systemic antibiotics generally reduce the incidence of intra-abdominal sepsis, while appropriate local treatment reduces the incidence of wound infection. Most reports on the chemoprophylaxis of sepsis after appendicectomy have been concerned solely with clinical aspects of infection and have not considered the nature of the infecting agents. During the last few years there has been an increasing awareness of the importance of non-sporing anaerobes as the major cause of sepsis after surgery of the gastrointestinal tract. Studies carried out at the Luton and Dunstable Hospital and subsequently at other centres have shown that systemic metronidazole, which is a specifically anaerobicidal agent, is highly effective in preventing the development of sepsis due to anaerobes in postappendicetomy patients.
Insights
Surgical sepsis is a common complication after appendicetomy. Systemic metronidazole effectively prevents anaerobic sepsis in post-appendicetomy patients, reducing infection rates.
Area of Science:
- Surgical Infections
- Microbiology
- Pharmacology
Background:
- Surgical sepsis is a frequent complication following appendicetomy, with incidence varying based on appendix condition.
- Existing prophylactic antibacterial agents have shown inconsistent effectiveness in reducing sepsis.
- There's a growing recognition of non-sporing anaerobes as primary causative agents in gastrointestinal surgery sepsis.
Purpose of the Study:
- To evaluate the efficacy of systemic metronidazole in preventing post-appendicetomy sepsis.
- To investigate the role of anaerobic bacteria in surgical sepsis after appendicetomy.
Main Methods:
- A review of clinical and microbiological data from post-appendicetomy patients.
- Administration of systemic metronidazole, an anaerobicidal agent, as a prophylactic measure.
- Analysis of sepsis development in relation to the identified infecting agents.
Main Results:
- Systemic metronidazole demonstrated high effectiveness in preventing sepsis caused by anaerobic bacteria.
- Previous prophylactic methods showed variable success, with systemic antibiotics reducing intra-abdominal sepsis and local treatments reducing wound infections.
- Non-sporing anaerobes are identified as the predominant cause of sepsis in this patient group.
Conclusions:
- Systemic metronidazole is a highly effective chemoprophylactic agent against anaerobic sepsis post-appendicetomy.
- Targeting anaerobic bacteria with specific agents like metronidazole is crucial for reducing post-appendicetomy sepsis.
- Further research should focus on the specific causative agents of surgical sepsis to optimize treatment strategies.