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Duration of antibiotic treatment after appendicectomy for acute complicated appendicitis

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After appendicectomy for complicated appendicitis, 3 days of antibiotic treatment is equally effective as 5 days in reducing postoperative infections.

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Duration of antibiotic treatment after appendicectomy for acute complicated appendicitis

  1. 1. Dr Arjun Rajagopalan BIOPSY
  2. 2. We know … • Clinically, appendicitis can be approached as uncomplicated (non-perforated) or complicated (perforation/ peritonitis). • Unlike uncomplicated appendicitis, the complicated variety is always treated surgically. • Perioperative antibiotic administration reduces complications (SSI, intra-abdominal abscess). We don’t know … • Although a 4 - 7 day course of antibiotics is commonly used, we don’t know the safe minimum period of antibiotic therapy. Dr Arjun Rajagopalan BIOPSY
  3. 3. 1: Population Patients operated upon for complicated (perforated) appendicitis (267) given: • Cefamandole 1000 mg + metronidazole 500 mg at induction of anesthesia. • Cefuroxime 750 mg TID, metronidazole 500 mg TID Antibiotic duration 9 123135 3 days 5 or more days Unknown Dr Arjun Rajagopalan BIOPSY
  4. 4. 3: Outcome variable Comparing 3 vs 5 days of antibiotic therapy Odds ratio 95% CI Which means Wound infection 2.74 0.54 - 13.8 No difference Intra-abdominal abscess 1.77 0.68 - 4.58 No difference No significant differences between open and laparoscopic approaches 2: Indicator variable 3 days of antibiotic therapy 4: Comparison 5 days of antibiotic therapy Dr Arjun Rajagopalan BIOPSY
  5. 5. The author(s) conclude … After appendicectomy for complicated appendicitis, 3 days of antibiotic treatment is equally effective as 5 days in reducing postoperative infections. Dr Arjun Rajagopalan BIOPSY
  6. 6. METHODOLOGY Type of study Interventional SAMPLING Centre Community hospital, 
 The Netherlands TIme frame Jan 2004 - Dec 2010 Analysis Retrospective A priori sample
 size calculation - Exclusions - Numbers 267 patients 3 day group - 135 5 day group - 123 COMPARISON Controls Yes Randomization ⛔ ️ Protocols/ training ⛔ ️ Comparability of groups Not stated MEASUREMENT Training - Blinding - Multiple observers - Duplication - BIOPSY The author(s) conclude … After appendicectomy for complicated appendicitis, 3 days of antibiotic treatment is equally effective as 5 days in reducing postoperative infections. Dr Arjun Rajagopalan

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