shiva sharma, breast/endocrine s.h.o. most common presentation requiring surgery great variability...
Post on 29-Dec-2015
213 Views
Preview:
TRANSCRIPT
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 coverageBroad-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 operatingHospital 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
top related