مقايسه اثر سفازولين با سفازولين همراه با مترونيدازول در پيش گيري از عفونت زخم وآبسه هاي داخل شكمي بعد از اعمال جراحي آپاندكتومي در آپانديسيت بدون عارضه

Comparison of the Effect of Cefazolin with Cefazolin Plus Metronidazole for Prophylaxis of Wound Infection and Intra Abdominal Abcess after Appendectomy for Uncomplicated Appendicitis

The goal of this research was to investigate whether at appendectomy for uncomplicated appendicitis (neither gangrenous nor perforated), the coverage of anaerobes with metronidazole for prophylaxis of infectious comlications of appendectomy has any additional benefit. Appendicitis is the most frequent cause of acute abdomen that requires surgery. The two complications of appendectomy are wound infection and intra abdominal abcess which are, however, uncommon after uncomplicated appendicitis, (about 5% and 1% respectively) but important from epidemiologic aspect due to high number of performed appendectomies. Prophylaxis with antibiotics against gr+ and gr and anaerobes is suggested for prevention of these two complications which includes cefazolin plus metronidazole or cefoxitin. However, the current problem is that metronidazole is relatively expensive and is not easily found and cefoxitin and cefotetan are not accessible in Iran. Therefore, none of these regimens is appropriate, accessible and inexpensive for wound infection prophylaxis and they are specially impractical in emergency situations. It is known that colonic anaerobes can almost never induce infection without companionship with aerobes; thus, theoretically it is expected that if antibiotics are just given against aerobes, anaerobes need not to be covered (for prophylaxis not for established infection). This randomized clinical trial study was carried out on patients at Rasoul-e-Akram Hospital who were operated on with diagnosis of simple appendicitis in 2003. The patients were divided into two groups: a group who received anti-anaerobe antibiotic (cefazolin plus metronidazole) compared with another group who did not receive anti anaerobe antibiotic (only cefazolin). Overally, 100 patients with pathologically established simple appendicitis were evaluated (each group had 50 patients). At each group one patient had wound infection (overall 2%) and intra abdominal abcess was not seen in any of the patients. Mean age, weight and operation time was not statistically different in two groups. Therefore, considering that no additional advantage was seen with metronidazole in this study, it seems that coverage of anaerobes for prophylaxis of infectious morbidity in simple appendicitis is not necessary. On the other hand, percentage of wound infection with cefazolin was 2% in this study that approximates the reported percentages with other standard antibiotics (1.9% in a study with cefotetan). Thus, it seems that cefazolin alone is an appropriate antibiotic for prophylaxis of infectious morbidity at simple appendicitis. However, since sample size and percentage of observed complications are low, definitive conclusion needs other studies with higher sample sizes.