Prophylactic metronidazole in appendicectomy: a controlled trial

Area of Science:

• Surgical Infection Prevention
• Pharmacology
• Clinical Microbiology

Background:

• Appendicectomy is a common surgical procedure with a risk of postoperative wound infections.
• Metronidazole is an antibiotic often used for anaerobic infections, but its efficacy in preventing surgical site infections in appendicitis requires evaluation.

Purpose of the Study:

• To compare the efficacy of prophylactic metronidazole with no treatment in preventing wound infections following appendicectomy.
• To assess the impact of prophylactic metronidazole on postoperative hospital stay and the types of infections occurring.

Main Methods:

• A randomized controlled trial involving patients undergoing appendicectomy.
• Intervention group received a 1-g metronidazole suppository and oral metronidazole for 7 days.
• Control group received no prophylactic antibiotic treatment.

Main Results:

• Fewer hospital wound infections occurred in the metronidazole group (4/87) compared to the no-treatment group (11/83), P < 0.05.
• Overall infection rates were not significantly different, with many infections occurring post-discharge.
• Postoperative hospital stay was significantly shorter in the metronidazole group (4.8 days) versus the control group (5.8 days), P < 0.01.
• Only one anaerobic infection was observed in the metronidazole group; late infections were not prevented.

Conclusions:

• Prophylactic metronidazole may reduce early, in-hospital wound infections after appendicectomy and shorten hospital stays.
• Metronidazole alone may not be sufficient to prevent all surgical site infections in appendicitis, particularly late-onset or those involving aerobic organisms.
• Further research into antibiotics effective against both aerobic and anaerobic bacteria may be warranted for appendicitis prophylaxis.