Complicated appendicitis: is there a minimum intravenous antibiotic requirement? A prospective randomized trial

Am Surg. 2000 Sep;66(9):887-90.

Abstract

The proper duration of postoperative intravenous (IV) antibiotics in patients suffering complicated (perforated or gangrenous) appendicitis is debatable. Some advocate a set minimum number of IV antibiotic days whereas others discontinue IV antibiotics depending on the patient's clinical course regardless of the length of therapy. Our objective was to determine whether there are differences in morbidity and resource utilization between the two treatment methodologies. Ninety-four patients with intraoperative findings of complicated appendicitis were included. In all patients IV antibiotics were discontinued on the basis of clinical factors. However, Group 1 patients were given a minimum 5-day IV antibiotic course whereas Group 2 patients had no minimum IV antibiotic requirement. Group 1 patients received more IV antibiotics than Group 2 patients did (5.9 vs 4.3 days; P = 0.014). Infectious complications were not statistically different between the two groups (13.0% in Group 1 and 12.5% in Group 2). Average hospital stay was also not statistically different between the two groups. The data suggest that a protocol with no minimum IV antibiotic requirement in patients with complicated appendicitis does not increase morbidity. Furthermore, the protocol arm with no minimum IV antibiotic requirement led to less IV antibiotic use but did not significantly decrease hospital stay.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Ampicillin / administration & dosage
  • Ampicillin / therapeutic use
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Antibiotic Prophylaxis*
  • Appendicitis / drug therapy
  • Appendicitis / surgery*
  • Case-Control Studies
  • Cephalexin / administration & dosage
  • Cephalexin / therapeutic use
  • Cephalosporins / administration & dosage
  • Cephalosporins / therapeutic use
  • Drug Therapy, Combination / administration & dosage
  • Drug Therapy, Combination / therapeutic use*
  • Female
  • Follow-Up Studies
  • Gangrene / drug therapy
  • Gangrene / surgery
  • Humans
  • Infusions, Intravenous
  • Intestinal Perforation / drug therapy
  • Intestinal Perforation / surgery*
  • Length of Stay
  • Male
  • Penicillins / administration & dosage
  • Penicillins / therapeutic use
  • Postoperative Complications
  • Prospective Studies
  • Sulbactam / administration & dosage
  • Sulbactam / therapeutic use
  • Time Factors

Substances

  • Anti-Bacterial Agents
  • Cephalosporins
  • Penicillins
  • Ampicillin
  • Cephalexin
  • Sulbactam