What is the effectiveness of intravenous (IV) antibiotics in preventing post-operative infections while awaiting an appendicectomy?

From the Guidelines

Intravenous antibiotics are highly effective in preventing post-operative infections while awaiting appendicectomy and should be administered as soon as appendicitis is diagnosed, with a recommended single preoperative dose of broad-spectrum antibiotics. The effectiveness of IV antibiotics in preventing post-operative infections is supported by high-quality evidence, including the 2020 update of the WSES Jerusalem guidelines 1.

Key Points

• The recommended regimen typically includes broad-spectrum antibiotics such as a combination of cefazolin and metronidazole, or piperacillin-tazobactam as a single agent.
• For patients with penicillin allergies, ciprofloxacin with metronidazole is an appropriate alternative.
• These antibiotics should be continued until surgery and, depending on the severity of appendicitis, may be continued post-operatively for 24 hours to 5-7 days.
• Early antibiotic administration reduces bacterial load in the infected appendix, decreases inflammation, and helps contain infection, which significantly lowers the risk of surgical site infections, intra-abdominal abscesses, and wound complications.

Evidence-Based Recommendations

• A single preoperative dose of broad-spectrum antibiotics is recommended in patients with acute appendicitis undergoing appendectomy 1.
• Postoperative antibiotics are suggested for patients with complicated acute appendicitis, especially if complete source control has not been achieved, but should not be prolonged longer than 3-5 days postoperatively in case of complicated appendicitis with adequate source control 1.
• The optimal course of antibiotics remains to be identified, but current evidence suggests that longer postoperative courses do not prevent surgical site infections compared with shorter courses 1.

Clinical Considerations

• Timely administration of antibiotics is crucial, ideally within one hour of diagnosis, as this has been shown to reduce complication rates by up to 50% in some studies.
• The antibiotics target both aerobic and anaerobic bacteria commonly found in appendicitis, including Escherichia coli, Bacteroides fragilis, and other enteric pathogens.

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 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 effectiveness of intravenous (IV) antibiotics, such as ceftriaxone, in preventing post-operative infections while awaiting an appendicectomy is supported by the drug label.

• Key points:
  • A single 1 gram dose of ceftriaxone may reduce the incidence of postoperative infections in patients undergoing surgical procedures classified as contaminated or potentially contaminated.
  • Ceftriaxone provides protection from most infections due to susceptible organisms throughout the course of the procedure. 2

From the Research

Effectiveness of IV Antibiotics in Preventing Post-Operative Infections

The effectiveness of intravenous (IV) antibiotics in preventing post-operative infections while awaiting an appendicectomy can be evaluated based on several studies.

• The use of IV antibiotics has been shown to reduce the incidence of post-operative complications, such as wound infections and intra-abdominal abscesses 3.
• A study published in 2014 found that antibiotic therapy, usually administered intravenously first, then orally, was effective in treating uncomplicated acute appendicitis, with a complication rate of 18% compared to 25% in the immediate appendectomy group 4.
• Another study published in 2006 found that IV antibiotic therapy was effective in treating acute appendicitis, with 86% of patients improving without surgery, although there was a risk of recurrence of symptoms 5.

Duration and Regimens of Antibiotic Treatment

The optimal duration and regimens of antibiotic treatment for preventing post-operative infections are not well established.

• A study published in 2017 found that a single dose of preoperative antibiotics (ceftriaxone and metronidazole) was sufficient in reducing surgical site infections (SSIs) after appendectomy for non-perforated appendicitis, and that postoperative antibiotics did not add an appreciable clinical benefit 6.
• Another study published in 2017 found that five days of cefuroxime and metronidazole did not lead to more SSIs compared to non-standardized antibiotic regimens, and decreased medical costs 7.

Key Findings

Key findings from the studies include:

• IV antibiotics can reduce the incidence of post-operative complications, such as wound infections and intra-abdominal abscesses 3.
• Antibiotic therapy can be effective in treating uncomplicated acute appendicitis, although there is a risk of recurrence of symptoms 4, 5.
• The optimal duration and regimens of antibiotic treatment are not well established, but single dose preoperative antibiotics or five days of cefuroxime and metronidazole may be sufficient in reducing SSIs 6, 7.