Summary
Metronidazole suppositories have previously been shown to be superior to povidone iodine intraoperative wound spray in reducing postappendicectomy wound sepsis. In subsequent studies metronidazole suppositories and cefotaxime injections reduced the sepsis rate to 9.3%, while the same combination produced a wound sepsis rate of 7.6% compared with 17.2% for cefotaxime alone. In an ongoing study, metronidazole and cefotaxime are now being compared with piperacillin in a single-blind trial.
Adult patients undergoing emergency appendicectomy in Nottingham have been included in this study, which has ethical committee approval. When the decision to perform emergency appendicectomy was made, the patient was randomly allocated a numbered pack. This contained either 3 × 1g injections of cefotaxime and 6 × 1g metronidazole suppositories or 3 × 2g injections of piperacillin and 6 placebos. 40 minutes before operation the patient received the first suppository and the remainder every 8 hours. The patient received the first injection of antibiotic by intravenous or intramuscular injection and the remaining doses 8 and 16 hours later. A wound was regarded as infected if pus discharged either spontaneously or on incision.
175 patients have been studied to date. The treatment groups were well matched for age and sex. Seven of the 77 patients in the cefotaxime/metronidazole group (9.1%) compared with 12 of the 76 in the piperacillin group (15.8%) have developed wound infections.
This study confirms that the combination of cefotaxime and metronidazole seems to be more effective than piperacillin alone in the reduction of postappendicectomy wound sepsis. Currently cefotaxime plus metronidazole is the therapy of choice.
Similar content being viewed by others
References
Bourke JB, Holliday A, Balfour TW, Foster GE. Cefotaxime and metronidazole compared with metronidazole alone in the management of post-appendicectomy wound sepsis. In Spitzy & Karrer (Eds) Proceedings of the 13th International Congress of Chemotherapy, Vol. 68, p. 24, Vienna, 1983
Bourke JB, Elliott J, Earnshaw J, et al. A comparison of cefotaxime alone and cefotaxime plus metronidazole in the management of post-operative wound sepsis following emergency appendicectomy. In Neu (Ed.) Cefotaxime, pp. 59–62, Excerpta Medica, Amsterdam, 1985a
Bourke JB, Holliday A, Balfour TW, Foster GE, Moulson AA, et al. Relationship between surgeons macroscopic diagnosis at emergency appendicectomy and the subsequent histology. Gut 26: A565, 1985b
Foster GE, Bourke JB, Bolwell J, Doran J, Balfour TW, et al. Clinical and economic consequence of wound sepsis after appendicectomy and their modification by metronidazole or povidone iodine. Lancet 1: 769–771, 1981
Holmes B, Richards DM, Brogden RN, Heel RC. Piperacillin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs 28: 375–425, 1984
Ljungquist V. Wound sepsis after clean operations. Lancet 2: 1095, 1964
Nie NH, Hadlaihull C, Jenkins JG, et al. Statistical package for the social sciences. McGraw Hill, New York, 1975
Willis AT, Ferguson IR, Jones PH, Phillips KD, Tearle PV, et al. Metronidazole in prevention and treatment of Bacteroides infection after appendicectomy. British Medical Journal 1: 318–321, 1976
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bourke, J.B., Balfour, T.W., Elliott, J. et al. Cefotaxime plus Metronidazole Appears More Effective than Piperacillin in the Prevention of Postappendicectomy Wound Sepsis. Drugs 35 (Suppl 2), 106–110 (1988). https://doi.org/10.2165/00003495-198800352-00023
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-198800352-00023