Skip to main content

Preoperative administration of antibiotics in patients with suspected acute appendicitis


The effectiveness of administering antibiotics preoperatively to patients with suspected appendicitis was evaluated over a 2-year period in 105 consecutive patients who presented with right lower quadrant (RLQ) tenderness and a white blood cell (WBC) count of over 10,000/mm3 or a temperature of over 37°C. All the patients were preoperatively administered cefazolin (CEZ), cefotiam (CTM), or fosfomycin (FOM) except those with apparent peritonitis, which resulted in the recovery of 41 patients (39%). Of the remaining 64 patients, 14 (13%) had catarrhal appendicitis, 34 (32%), phlegmonous appendicitis, and 16 (15%), gangrenous appendicitis. Preoperatively, there were no significant differences among these groups in the WBC count or temperature. Following the administration of antibiotics, both these parameters decreased significantly in the patients with catarrhal appendicitis, although a slight RLQ tenderness persisted; in those with phlegmonous appendicitis, the WBC count decreased significantly, but the temperature remained elevated, with slight rebound tenderness in the RLQ; and in those with gangrenous appendicitis, there were no significant differences between the pre- and postoperative data in WBC count or temperature, and the abdominal symptoms did not change. These results show the value of administering antibiotics within 24h of the onset of symptoms indicative of acute appendicitis to allow time to evaluate the patients' condition, decide the operative indications, and prevent unnecessary laparotomy.

This is a preview of subscription content, access via your institution.


  1. 1.

    Puylaert JBCM (1986) Acute appendicitis: US evaluation using graded compression. Radiology 158:355–360

    Google Scholar 

  2. 2.

    Karstrup S, Torp-Pedersen S, Roikjaer O (1986) Ultrasonic visualisation of the inflamed appendix. Br J Radiol 59:985–986

    Google Scholar 

  3. 3.

    Adams DH, Fine C, Brooks DC (1988) High-resolution real-time ultrasonography. A new tool in the diagnosis of acute appendicitis. Am J Surg 155:93–97

    Google Scholar 

  4. 4.

    Fa EM, Cronan JJ (1989) Compression ultrasonography as an aid in the differential diagnosis of appendicitis. Surg Gynecol Obstet 169:290–298

    Google Scholar 

  5. 5.

    Jeffrey RB, Laing FC, Lewis FR (1987) Acute appendicitis: High-resolution real-time US findings. Radiology 163:11–14

    Google Scholar 

  6. 6.

    Gale ME, Birnbaum S, Gerzof SG, Sloan G, Johnson WC, Robbins AH (1985) CT appearance of appendicitis and its local complications. J Comp Assist Tomogr 9:34–37

    Google Scholar 

  7. 7.

    Balthazar EJ, Megibow AJ, Hulnick D, Gordon RB, Naidich DP, Beranbaum ER (1986) CT of appendicitis. AJR 147:705–710

    Google Scholar 

  8. 8.

    Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C (1994) Acute appendicitis: CT and US correlation in 100 patients. Radiology 190:31–35

    Google Scholar 

  9. 9.

    Malone AJ Jr, Wolf CR, Malmed AS, Melliere BF (1993) Diagnosis of acute appendicitis: Value of enhanced CT. AJR 160:763–766

    Google Scholar 

  10. 10.

    Lewis FR, Holcroft JW, Boey J, Dunphy E (1975) Appendicitis: a critical review of diagnosis and treatment in 1,000 cases. Arch Surg 110:677–684

    Google Scholar 

  11. 11.

    Owens BJ, Hamit HF (1978) Appendicitis in the elderly. Ann Surg 187:392–396

    Google Scholar 

  12. 12.

    Thorbjarnarson B, Loehr WJ (1967) Acute appendicitis in patients over the age of sixty. Surg Gynecol Obstet 125:1277–1280

    Google Scholar 

  13. 13.

    Lau WY, Fan ST, Yip WC, Chu KW, Yiu TF, Yeung C, Wong KK (1987) Acute appendicitis in children. Aust NZ J Surg 57:927–931

    Google Scholar 

  14. 14.

    Scher KS, Coil JA (1980) The continuing challenge of perforating appendicitis. Surg Gynecol Obstet 150:535–538

    Google Scholar 

  15. 15.

    Fee HJ, Jones PC, Kadell B, O'Connell TX (1977) Radiologic diagnosis of appendicitis. Arch Surg 112:742–744

    Google Scholar 

  16. 16.

    Rajagopalan AE, Mason JH, Kennedy M, Pawlikowski J (1977) The value of the barium enema in the diagnosis of acute appendicitis. Arch Surg 112:531–533

    Google Scholar 

  17. 17.

    Leape LL, Ramenofsky ML (1980) Laparoscopy for questionable appendicitis. Can it reduce the negative appendectomy rate? Ann Surg 191:410–413

    Google Scholar 

  18. 18.

    Whitworth CM, Whitworth PW, Sanfillipo J, Polk HC (1988) Value of diagnostic laparoscopy in young women with possible appendicitis. Surg Gynecol Obstet 167:187–190

    Google Scholar 

  19. 19.

    Wade DS, Morrow SE, Balsara ZN, Burkhard TK, Goff WB (1993) Accuracy of ultrasound in the diagnosis of acute appendicitis compared with the surgeon's clinical impression. Arch Surg 128:1039–1046

    Google Scholar 

  20. 20.

    Sarfati MR, Hunter GC, Witzke DB, Bebb GG, Smythe SH, Boyan S, Rappaport WD (1993) Impact of adjunctive testing on the diagnosis and clinical course of patients with acute appendicitis. Am J Surg 166:660–665

    Google Scholar 

  21. 21.

    Tate JJT, Chung SCS, Dawson J, Leong HT, Chan A, Lau WY, Li AKC (1993). Conventional versus laparoscopic surgery for acute appendicitis. Br J Surg 80:761–764

    Google Scholar 

  22. 22.

    McNamara MJ, Pasquale MD, Evans SRT (1993) Acute appendicitis and the use of intraperitoneal cultures. Surg Gynecol Obstet 177:393–397

    Google Scholar 

  23. 23.

    Schropp KP, Kaplan Jr S, Golladay ES, King DR, Pokorny W, Mollitt DL, Wise WE, Mason EO (1991) A randomized clinical trial of ampicillin, gentamicin and clindamycin versus cefotaxime and clindamycin in children with ruptured appendicitis. Surg Gynecol Obstet 172:351–356

    Google Scholar 

  24. 24.

    David IB, Buck JR, Filler RM (1982) Rational use of antibiotics for perforated appendicitis in childhood. J Pediatr Surg 17:494–500

    Google Scholar 

  25. 25.

    Elmore JR, Dibbins AW, Curci MR (1987) The treatment of complicated appendicitis in children. Arch Surg 122:424–427

    Google Scholar 

  26. 26.

    Sirinek KR, Levine BA (1991) A randomized trial of ticarcillin and clavulanate versus gentamicin and clindamycin in patients with complicated appendicitis. Surg Gynecol Obstet [Suppl 172]:30–35

    Google Scholar 

  27. 27.

    Bauer T, Vennits B, Holm B, Hahn-Pedersen J, Lysen D, Galatius H, Kristensen ES, Graversen P, Wilhelmsen F, Skjoldborg H, Malmfred S, Villadsen J, Bendix J (1989) Antibiotic prophylaxis in acute nonperforated appendicitis. Ann Surg 209:307–311

    Google Scholar 

Download references

Author information



Rights and permissions

Reprints and Permissions

About this article

Cite this article

Murao, Y., Ueda, S. & Miyamoto, S. Preoperative administration of antibiotics in patients with suspected acute appendicitis. Surg Today 26, 314–322 (1996).

Download citation

Key Words

  • acute appendicitis
  • antibiotics
  • preoperative administration
  • differential diagnosis
  • operative indication