appanb - Pilgrims Hospital
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Transcript appanb - Pilgrims Hospital
Shiva Sharma, Breast/Endocrine S.H.O
Most common presentation requiring surgery
Great variability with regards to:
Timing
Choice
Route of administration
Instances of use
Perforated vs. Non-Perforated appendicitis
Pre-operative antibiotics
Needed?
Benefit vs. Cost
Timing
How long?
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
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
Cost of antibiotics
Monetary
Risk of reaction
Antibiotic related secondary infection
Resistance
Cost of out of hours operating
Hospital beds
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
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
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
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.Clyde etal; Am. Journal of Surgery (2008) 195; 590
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
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
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
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