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Appendicitis treated with antibiotics

Shiva Sharma, Breast/Endocrine S.H.O. Appendicitis treated with antibiotics. Introduction. Most common presentation requiring surgery Great variability with regards to: Timing Choice Route of administration Instances of use. Perforated vs. Non-Perforated appendicitis

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Appendicitis treated with antibiotics

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  1. Shiva Sharma, Breast/Endocrine S.H.O Appendicitis treated with antibiotics

  2. Introduction • Most common presentation requiring surgery • Great variability with regards to: • Timing • Choice • Route of administration • Instances of use

  3. Perforated vs. Non-Perforated appendicitis • Pre-operative antibiotics • Needed? • Benefit vs. Cost • Timing • How long?

  4. The use of antibiotics in perforated well est. • Risk of intra-abdominal contamination • Risk of abscess formation • Triple therapy previously • Gram positive, Gram negative and aerobic coverage • Broad-spectrum single or double agent therapy as effective

  5. Needed? • Morbidity • Wound infection • Intra-abdominal abscess • Timing of surgery • Presenting with NPA progressing to perforation • Time of presentation to time of surgery • Sepsis increases as appendicitis progresses

  6. Cost vs. Benefit • Cost of antibiotics • Monetary • Risk of reaction • Antibiotic related secondary infection • Resistance • Cost of out of hours operating • Hospital beds

  7. Duration • 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

  8. Duration 2 • 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

  9. Timing • 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

  10. Timing 2 • No relation between timing to surgical intervention and length of hospital stay • Complications more related to NPA vs. Perforated • Paper does not specify if antibiotics are used • Suggests that surgery can be delayed provided infection can be controlled • C.Clydeetal; Am. Journal of Surgery (2008) 195; 590

  11. Antibiotics and appendicitis in the pediatric population – Systematic Review • Presented at the 2010 Meeting of the American Pediatric Surgical Association • Review of PubMed and other English Literature up to 2009

  12. 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

  13. 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

  14. References • 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

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