Single Dose Of Preoperative Antibiotics Research Articles

A PROSPECTIVE RANDOMIZED TRIAL TO COMPARE ONE DOSE PREOPERATIVE, THREE‐DOSE PERIOPERATIVE AND 5‐DAY FULL COURSE ANTIBIOTICS FOR NON‐PERFORATED ACUTE APPENDICITIS

Background: Although prophylatic antibiotics has been proven to be effective in reducing wound complications after appendectomy, the most efficacous dosage remains uncertain.Aim:To determine the optimal duration of antibiotics after appendectomy for non‐perforated acute appendicitis.Methods: From July 1995 to December 2000, all patients aged between 15 and 70 years with appendectomy performed via a right lower abdominal incision were considered for the study. Exclusion criteria included pre‐admission antibiotics, diabetes mellitus, known drug allergy and ruptured appendicitis. Intravenous Cefuroxime, 1.5g, and Metronidazole, 500 mg were given at induction of anaesthesia. After appendectomy, patients were randomized to one of the three treatment protocols: (A) no further antibiotics, (B) 2 more doses of antibiotics, or (C) a 5‐day course of antibiotics. Outcomes of surgery were compared using 1‐way ANOVA or Chi‐square where appropriate.Results: Of 275 patients recruited, 6 had normal appendix revealed by histology and were excluded. Treatment A, B and C were assigned to 92, 94 and 83 patients, respectively. The 3 groups were comparable in demographics and pre‐operative characteristics. The outcomes were as follows: Conclusions: A single dose of preoperative antibiotics is adequate for prevention of wound infection in non‐perforated appendicitis. Prolonged use of antibiotics is cost‐ineffective and may lead to unnecessary complications.

Predictive Factors for Bactibilia in Acute Cholecystitis

Acute cholecystitis is well established as one of the high-risk factors bactibilla and wound infection. However, many patients with acute cholecystitis do not have bactibillia. Therefore, we analyzed 20 clinical and laboratory parameters in 49 patients with acute cholecystitis to determine which factor(s) predicted bactibilla. Twenty-one (42.9%) of 49 patients with pathologically proved acute cholecystitis had positive bile and/or gallbladder wall cultures. Univariate analysis suggested that a preoperative temperature greater than 37.3 degrees C, a total serum bilirubin level greater than 8.6 mumol/L, and a white blood cell count greater than 14.1 x 10(9)/L were the best predictors of bactibilia. Multifactorial analysis demonstrated that the 17 patients with zero or one predictive factor had a significantly lower chance of having bactibilia than the 32 patients with two or three predictive factors (6% vs 63%). We concluded that the culture status of patients with acute cholecystitis can be predicted preoperatively. We propose that patients with acute cholecystitis and zero or one of the predictive factors receive a single preoperative antibiotic dose. In patients with two or three predictive factors, antibiotics should be continued until culture data are available.

Value of single dose preoperative antibiotics in acute appendicitis

Value of single dose preoperative antibiotics in acute appendicitis