From the Guidelines
For prophylaxis in appendectomy, ceftriaxone or a combination of cefazolin plus metronidazole can be used. The choice of antibiotic should be based on the type of surgical procedure and probable causative pathogens and their resistance patterns 1. According to recent guidelines, for uncomplicated appendicitis, a single preoperative dose of a second-generation cephalosporin (such as cefoxitin or cefotetan) or a combination of cefazolin plus metronidazole is recommended 1. Some key points to consider when choosing prophylactic antibiotics for appendectomy include:
- Selecting the right antibiotic based on the type of surgical procedure and probable causative pathogens and their resistance patterns 1
- Using a single preoperative dose of a broad-spectrum antibiotic, such as a second-generation cephalosporin or a combination of cefazolin plus metronidazole 1
- Considering alternative antibiotics for cases of known or highly suspected allergies, such as vancomycin or clindamycin 1
- Administering prophylactic antibiotics within 60 minutes before surgical incision to ensure adequate tissue concentrations at the time of incision 1. In terms of specific options, some possibilities include:
- Ceftriaxone, which is a third-generation cephalosporin with broad-spectrum activity 1
- Cefazolin plus metronidazole, which provides coverage against both aerobic and anaerobic organisms 1
- Other options, such as ampicillin-sulbactam or piperacillin-tazobactam, may also be considered in certain situations 1. It's worth noting that the use of prophylactic antibiotics in appendectomy is supported by high-quality evidence, and is recommended by recent guidelines 1.
From the FDA Drug Label
The preoperative administration of a single 1 gram dose of Ceftriaxone for Injection may reduce the incidence of postoperative infections in patients undergoing surgical procedures classified as contaminated or potentially contaminated (e.g., vaginal or abdominal hysterectomy or cholecystectomy for chronic calculous cholecystitis in high-risk patients, such as those over 70 years of age, with acute cholecystitis not requiring therapeutic antimicrobials, obstructive jaundice or common duct bile stones) and in surgical patients for whom infection at the operative site would present serious risk (e.g., during coronary artery bypass surgery). Although Ceftriaxone for Injection has been shown to have been as effective as cefazolin in the prevention of infection following coronary artery bypass surgery, no placebo-controlled trials have been conducted to evaluate any cephalosporin antibiotic in the prevention of infection following coronary artery bypass surgery When administered prior to surgical procedures for which it is indicated, a single 1 gram dose of Ceftriaxone for Injection provides protection from most infections due to susceptible organisms throughout the course of the procedure.
The medication that can be used as prophylaxis in appendectomy is:
- Ceftriaxone [@\1@] Note that appendectomy is considered a contaminated surgical procedure, and Ceftriaxone for Injection may reduce the incidence of postoperative infections in such cases.
From the Research
Medications for Prophylaxis in Appendectomy
The following medications can be used as prophylaxis in appendectomy:
Rationale for Medication Choice
The choice of medication is based on the effectiveness of the antibiotic in preventing postoperative infectious complications.
- Ceftriaxone is a third-generation cephalosporin with a broad spectrum of activity against Gram-positive and Gram-negative aerobic, and some anaerobic, bacteria 2.
- Metronidazole is effective against anaerobic bacteria and is often used in combination with other antibiotics 4, 5, 3.
- Ampicillin is a beta-lactam antibiotic that can be used in combination with a beta-lactamase inhibitor, such as sulbactam, to broaden its spectrum of activity 5.
- Cefotaxime is a third-generation cephalosporin with a broad spectrum of activity against Gram-positive and Gram-negative aerobic, and some anaerobic, bacteria 5.
Specific Studies
- A study published in 1991 found that the use of antimicrobial prophylaxis in appendectomy reduced the rate of postoperative infectious complications 4.
- A study published in 2017 found that a single dose of preoperative antibiotics (ceftriaxone and metronidazole) was sufficient in reducing surgical site infections after appendectomy for non-perforated appendicitis 3.
- A study published in 1986 found that the combination of sulbactam and ampicillin was effective in preventing sepsis following appendectomy 5.