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Prophylactic metronidazole in appendicectomy: a controlled trial
Abstract:
Prophylactic metronidazole was compared with no treatment in a randomly allocated study of patients undergoing appendicectomy. A 1-g suppository of metronidazole was given with the premedication and 200 mg t.d.s. orally for 7 days thereafter. There were 4 hospital wound infections in the 87 patients receiving metronidazole and 11 out of 83 in the no-treatment group (P < 0.05). However, 60 per cent of wound infections occurred at home and the overall infection rates were not significantly different. The duration of postoperative hospital stay was longer in the control group (5.8 days +/- 3.0 s.d.) than in the treated group (4.8 +/- 2.3; P < 0.01). Only one anaerobic infection occurred in a patient receiving metronidazole but late infection was not prevented. Blood levels of metronidazole taken at the end of operation showed a wide variation but there was no correlation with subsequent infection. Culture of the appendix showed aerobic organisms in 88 per cent of cases and anaerobes in 72 per cent. It is suggested that an antibiotic which is effective against both aerobic and anaerobic organisms might have an advantage over metronidazole in appendicitis.
Insights
Prophylactic metronidazole reduced early hospital wound infections after appendicectomy but did not significantly alter overall infection rates. Patients receiving metronidazole had shorter hospital stays, suggesting potential benefits despite limitations in preventing late infections.
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.