Shiva Sharma, Breast/Endocrine S.H.O
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Most common presentation requiring surgery
Great variability with regards to:
 Timing
 Choice
 Route of administration
 Instances of use
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Perforated vs. Non-Perforated appendicitis
Pre-operative antibiotics
 Needed?
 Benefit vs. Cost
 Timing
 How long?
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The use of antibiotics in perforated well est.
 Risk of intra-abdominal contamination
 Risk of abscess formation
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Triple therapy previously
 Gram positive, Gram negative and aerobic
coverage
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Broad-spectrum single or double agent
therapy as effective
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Morbidity
 Wound infection
 Intra-abdominal abscess
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Timing of surgery
 Presenting with NPA progressing to perforation
 Time of presentation to time of surgery
 Sepsis increases as appendicitis progresses
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Cost of antibiotics
 Monetary
 Risk of reaction
 Antibiotic related secondary infection
 Resistance
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Cost of out of hours operating
Hospital beds
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Optimum duration of prophylactic antibiotics
in non-perforated appendicitis
Following underwent emergency open
appendicectomies
 Group A: single dose antibiotic pre-operative
 Group B: Three dose/1 Day
 Group C: 5 day peri-operative course
 Results: no significant impact on length of
hospital stay
 Wound infection rates
▪ 6.5%, 6.4%, 3.6%
 Increase in antibiotic related complications in the
5day group
▪ 0%, 1.1%, 4.8%
▪ L.M. Mui etal. ANZ Journal of Surgery. 2005; 75:425
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Timing of intervention does not affect
outcome in acute appendicitis
 Retrospective study
 1198 patients
 Mean time to surgery 7.1hr, range 1-24hr
 Concluded: short delays from time to surgery well
tolerated
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No relation between timing to surgical intervention and length of
hospital stay
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Complications more related to NPA vs. Perforated
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Paper does not specify if antibiotics are used
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Suggests that surgery can be delayed provided infection can be
controlled
▪ C.Clyde etal; Am. Journal of Surgery (2008) 195; 590
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Antibiotics and appendicitis in the pediatric
population – Systematic Review
 Presented at the 2010 Meeting of the American
Pediatric Surgical Association
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Review of PubMed and other English
Literature up to 2009
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Grade A evidence to support children should
receive preoperative antibiotics
Cochrane review supports single dose
preoperative antibiotics
Significant decrease in wound infection and
intra-abdominal abscess
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Grade B evidence to support single or double
agent antibiotics in perforated cases
More effective, cost effective and similar
rates as triple therapy
Total course of antibiotics should be 7 days
 Minimum 5 days IV
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Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical
Association Outcomes and Clinical Trials Committee Systematic Review; S.L. Lee etal.
Journal of Pediatric Surgery (2010) 45, 2181
Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of
postoperative infection after appendectomy Cochrane Database Syst Rev 2005;3
Donovan, I. A., D. Ellis, D. Gatehouse, G. Little, R. Grimley, S.Armstead, M. R. B. Keighley,
and C. J. C. Strachan. 1979. One dose antibiotic prophylaxis against wound infection after
appendectomy. A randomized trial of clindamycin, cefazolin sodium and a placebo. Br. J.
Surg. 66:193-196.
Timing of intervention does not affect outcome in acute appendicitis. L.M. Mui etal. ANZ
Journal of Surgery. 2005; 75:4
Timing of intervention does not affect outcome in acute appendicitis in a large community
practice; The American Journal of Surgery (2008) 195, 590–593