Single dose intra-rectal metronidazole as prophylaxis against wound infection following emergency appendicectomy

Area of Science:

• Surgical prophylaxis
• Infectious disease prevention
• Clinical trial methodology

Background:

• Appendicitis is a common surgical emergency.
• Surgical site infections (SSIs) are a significant complication following appendectomy.
• Antibiotic prophylaxis is standard practice to reduce SSI rates.

Purpose of the Study:

• To evaluate the efficacy of a single intra-rectal dose of metronidazole for surgical site infection prophylaxis in patients undergoing appendectomy.
• To compare the incidence of wound infections between patients receiving metronidazole and those receiving a placebo.

Main Methods:

• A prospective, placebo-controlled, randomized trial.
• 104 patients with acute appendicitis were included.
• A single 1g intra-rectal dose of metronidazole was administered 1 hour preoperatively to the intervention group.

Main Results:

• A significantly lower wound infection rate was observed in the metronidazole group (1 out of 54) compared to the placebo group (15 out of 50).
• This represents a substantial reduction in surgical site infections.
• The intra-rectal metronidazole regimen was well-tolerated.

Conclusions:

• A single intra-rectal dose of metronidazole is an adequate and effective regimen for surgical prophylaxis in appendicitis.
• This finding supports the established value of metronidazole in preventing surgical site infections.
• The study suggests a simplified prophylactic protocol may be sufficient.