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

1. Dr Arjun Rajagopalan
BIOPSY

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. 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. 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. 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. 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