Document Type : Original Article


1 Department of General Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran

2 Baqiyatallah University of Medical Sciences, Tehran, IR Iran

3 Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran


Background: Acute appendicitis is one of the most common acute surgery events. Its main treatment is surgery. However medical management before and after the surgery has an important impact on the treatment.
Objective: The aim of study was evaluating the outcomes of single dose and quadruple doses of prophylactic antibiotic therapy in patients with acute non-complicated appendicitis.
Methods: This randomized double blind clinical trial was carried out on 294 patients in single dose (136 patients) and the quadruple doses (158 patients) groups. In single dose group, a dose of 1g Cefazolin + 500mg Metronidazole was prescribed intravenously about half an hour before surgery. The quadruple doses group received three more doses after surgery.  Two groups were followed for fever, erythema, seroma, wound infection, intra-abdominal abscess formation and readmissions within one month after discharge.
Results: The mean age of patients was 31±5.14 years. 203(69%) of patients were men while 91(31%) were women. There were no significant statistical differences between groups in age, sex and body mass index (BMI) variables. No significant statistical differences were observed during surgery and hospitalization period between two groups. In the single dose group, wound infection was 8(5.9%), while it was 6(3.8%) in the quadruple doses group; hence, there were no significant statistical differences in this regard. There was no abdominal abscess in groups. There were significant statistical differences regarding erythema, seroma and antibiotics consumption costs between groups.
Conclusion: A single dose of prophylactic antibiotics is sufficient in patients with acute suppurative non-complicated appendicitis.


  1. Brunicardi F, Anderson D, Billiar T, Dunn D, Hunter J, Pollock RE, et al. Schwartzs Current Practice of General Surgery (EBOOK): McGraw Hill Professional; 2014.
  2. Townsend Jr CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston textbook of surgery: Elsevier Health Sciences; 2012.
  3. Ashley SW, Zinner M. Maingot's abdominal operations: McGraw-Hill Publishing; 2007.
  4. Mason RJ, Moazzez A, Sohn H, Katkhouda N. Meta-analysis of randomized trials comparing antibiotic therapy with appendectomy for acute uncomplicated (no abscess or phlegmon) appendicitis. Surg Infect (Larchmt). 2012;13(2):74-84. doi: 10.1089/sur.2011.058
  5. Hawkins RB, Levy SM, Senter CE, Zhao JY, Doody K, Kao LS, et al. Beyond surgical care improvement program compliance: antibiotic prophylaxis implementation gaps. Am J Surg. 2013;206(4):451-6. doi: 10.1016/j.amjsurg.2013.02.009
  6. Wray CJ, Kao LS, Millas SG, Tsao K, Ko TC. Acute appendicitis: controversies in diagnosis and management. Curr Probl Surg. 2013;50(2):54-86. doi: 10.1067/j.cpsurg.2012.10.001
  7. Coakley BA, Sussman ES, Wolfson TS, Bhagavath AS, Choi JJ, Ranasinghe NE, et al. Postoperative antibiotics correlate with worse outcomes after appendectomy for nonperforated appendicitis. J Am Coll Surg. 2011;213(6):778-83. doi: 10.1016/j.jamcollsurg.2011.08.018
  8. Enzler MJ, Berbari E, Osmon DR, editors. Antimicrobial prophylaxis in adults. Mayo Clinic Proceedings; 2011: Elsevier.
  9. Daskalakis K, Juhlin C, Påhlman L. The use of pre-or postoperative antibiotics in surgery for appendicitis: a systematic review. Scand J Surg. 2014;103(1):14-20. doi: 10.1177/1457496913497433
  10. Wu W-T, Tai F-C, Wang P-C, Tsai M-L. Surgical Site Infection and Timing of Prophylactic Antibiotics for Appendectomy. Surg Infect (Larchmt). 2014;15(6):781-5. doi: 10.1089/sur.2013.167
  11. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. doi: 10.2146/ajhp120568
  12. Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev. 2005;3:CD001439. doi: 10.1002/14651858.cd001439.pub2
  13. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect (Larchmt). 2010;11(1):79-109. doi: 10.1089/sur.2009.9930
  14. Khan MN, Fayyad T, Cecil TD, Moran BJ. Laparoscopic versus open appendectomy: the risk of postoperative infectious complications. JSLS. 2007;11(3):363.
  15. Kasatpibal N, Nørgaard M, Sørensen HT, Schønheyder HC, Jamulitrat S, Chongsuvivatwong V. Risk of surgical site infection and efficacy of antibiotic prophylaxis: a cohort study of appendectomy patients in Thailand. BMC Infect Dis. 2006;6:111. doi: 10.1186/1471-2334-6-111
  16. Liberman MA, Greason KL, Frame S, Ragland JJ. Single-dose cefotetan or cefoxitin versus multiple-dose cefoxitin as prophylaxis in patients undergoing appendectomy for acute nonperforated appendicitis. J Am Coll Surg. 1995;180(1):77-80.
  17. Mui LM, Ng CS, Wong SK, Lam YH, Fung TM, Fok KL, et al. Optimum duration of prophylacticantibiotics in acute non-perforated appendicitis. ANZ J Surg. 2005;75(6):425-8. doi: 10.1111/j.1445-2197.2005.03397.x
  18. Hussain MI, Alam MK, Al-Qahatani HH, Al-Akeely MH. Role of postoperative antibiotics after appendectomy in non-perforated appendicitis. J Coll Physicians Surg Pak. 2012;22:756-9.
  19. Ravari H, Jangjoo A, Motamedifar J, Moazzami K. Oral metronidazole as antibiotic prophylaxis for patients with nonperforated appendicitis. Clin Exp Gastroenterol. 2011;4:273. doi: 10.2147/CEG.S18153
  20. Ali K, Latif H, Ahmad S. Frequency of wound infection in non-perforated appendicitis with use of single dose preoperative antibiotics. J Ayub Med Coll Abbottabad. 2015;27(2):378-80.