Preoperative IV Antibiotics Improve Surgical Safety
The correct answer is B: Pre-operative IV antibiotics administered 0-60 minutes before surgical incision will most improve surgical safety in this patient. This is the single most evidence-based intervention among the options that directly reduces postoperative infectious complications and mortality in appendectomy. 1
Why Preoperative Antibiotics Are Critical
A single preoperative dose of broad-spectrum antibiotics administered 0-60 minutes before skin incision is mandatory for all appendectomy cases, whether complicated or uncomplicated, to reduce surgical site infections and intra-abdominal abscesses. 2, 1
Broad-spectrum coverage targeting enteric gram-negative organisms and anaerobes is essential. Recommended regimens include piperacillin-tazobactam, ampicillin-sulbactam, or ceftriaxone plus metronidazole. 3, 4
The presence of fever (>38°C) in this patient suggests more severe inflammation, making antibiotic prophylaxis even more critical to prevent progression to sepsis and reduce postoperative complications. 5, 4
Clinical trials with placebo controls demonstrate clear reduction in postoperative infectious complications across all types of appendicitis, including non-perforated cases. 5
Why the Other Options Are Inadequate or Wrong
Option A (Site Marking and Equipment Preparation)
- While standard surgical safety practices, these are routine baseline requirements, not specific interventions that improve outcomes in appendectomy beyond what is already expected. 6
- Site marking is more relevant for lateralized procedures; appendectomy location is anatomically defined. 6
Option C (Ignoring Asthma History)
- This is dangerous and violates basic perioperative care principles. Even well-controlled asthma requires perioperative assessment for anesthetic risk stratification. 6
- Laparoscopic surgery with pneumoperitoneum can affect respiratory mechanics, making asthma history clinically relevant. 6
Option D (Not Taking Consent)
- This is medically and legally indefensible. Appendectomy carries risks including bleeding, infection, injury to adjacent structures, and conversion to open surgery. 6
- Informed consent is mandatory regardless of procedure complexity. 6
Specific Antibiotic Recommendations for This Patient
First-line regimen: Cefazolin 2g IV (covers S. aureus, E. coli, and common surgical pathogens) OR piperacillin-tazobactam 3.375g IV (broader anaerobic coverage). 7, 4
Alternative if beta-lactam allergy: Clindamycin plus gentamicin or a fluoroquinolone plus metronidazole. 3, 5
Timing is critical: Administer within 0-60 minutes before incision, ideally at anesthesia induction. 1, 8
For uncomplicated appendicitis with adequate source control, no postoperative antibiotics are needed beyond the single preoperative dose. 2, 1
Common Pitfalls to Avoid
Do not delay antibiotics to "wait for cultures"—prophylaxis must be given preoperatively, not after incision. 1, 8
Do not use narrow-spectrum agents (e.g., first-generation cephalosporins alone in high-risk cases)—ensure anaerobic coverage. 3, 5
Do not extend antibiotics beyond 3-5 days even in complicated cases with adequate source control, as this promotes resistance without benefit. 2, 1
Do not dismiss the asthma history—coordinate with anesthesia for bronchodilator optimization and avoid histamine-releasing agents if possible. 6