A comparative study to determine the role of pre and post-operative antibiotic therapy versus only pre-operative antibiotic therapy in patients of non-perforated acute appendicitis

Goutam K. Chowdegowda, Satya V. Arya, Ashok K. Sharma, Dheer Singh Kalwaniya, Jaspreet Singh Bajwa


Background: If properly used in appendicitis, antibiotics can reduce the rate of infection by 50%. The use of post-operative antibiotics for preventing infective complications in non-perforated cases is still controversial.

Methods: A randomised prospective study was conducted in the Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi with patients who presented acute appendicitis. A minimum number of 30 patients each in group A (pre-operative and post-operative antibiotics) and group B (only pre-operative antibiotics) were evaluated for 18 months, from January 2018 to June 2019.

Results: The mean age of group A is 29.9±15.16 years and in group B is 25.97±9.470 years (p value=0.122, insignificant). There was male preponderance. The seroma formation in both the groups was 10.00% and no patients developed intra-abdominal abscess. The incidence of local site oedema was 10% in both the groups A and B and their p value is insignificant. In both the groups A and B, 10% of the people developed pus discharge from the stitch line and the p value is insignificant. In group A, 6.67% of the patients and in group B 10.00% of the patients developed stitch line inflammatory changes and the p value insignificant. In group A, 13.3% and in group B, 10.00% of the patients developed fever and their p value is 1. The mean length of hospital in case 1.23±0.5 days (group A) and is 1.17±0.45 days (group B) (p value=0.508).

Conclusions: Hence we can conclude that a well-chosen and adequately-timed pre-operative antibiotics are adequate in preventing post-operative complications and post-operative antibiotics do not affect the same.


Acute appendicitis, Seroma, Surgical site infections

Full Text:



Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiology 132: 910–925.

Williams GR (1983) Presidential Address: a history of appendicitis. With anecdotes illustrating its importance. Ann Surg 197: 495–506.

Nitecki S, Karmeli R, Sarr MG (1990) Appendiceal calculi and fecaliths as indications for appendectomy. Surg Gynecol Obstet171: 185–188.

Williams NM, Jackson D, Everson NW, Johnstone JM (1998) Is the incidence of acute appendicitis really falling? Ann R Coll Surg Engl 80: 122–124.

Al-Omran M, Mamdani M, McLeod RS (2003) Epidemiologic features of acute appendicitis in Ontario, Canada. Can J Surg 46: 263–268.

O’Connell PR, The vermiform appendix. In: Williams NS, Bulstrode CJK, O’Connell PR, editors. Bailey and Love’s short practice of surgery. 26th ed. London, UK: Edward Arnold Ltd, 2013.p.1199-1201.

Andersson RE: Appendicitis: Epidemiology and diagnosis. Doctoral Thesis, Linköpingsuniversitet, Sweden, 1998.

MehrabiBahar M, Jangjoo A, Amouzeshi A, Kavianifar K. Wound infection incidence in patients with simple and gangrenous or perforated appendicitis. Arch Iran Med 2010;13:13–6.

Chamisa I. A clinicopathological review of 324 appendices removed for acute appendicitis in Durban, South Africa: a retrospective analysis. Ann R Coll Surg Engl2009;91:688–92.

Bickel A, Gurevits M, Vamos R, Ivry S, Eitan A. Perioperative hyperoxygenation and wound site infection following surgery for acute appendicitis: a randomized, prospective, controlled trial. Arch Surg 2011;146:464–70.

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.

Fraser JD, Aguayo P, Leys CM, Keckler SJ, Newland JG, Sharp SW, et al. A complete course of intravenous antibiotics vs. a combination of intravenous and oral antibiotics for perforated appendicitis in children: a prospective, randomized trial. Pediatr Surg 2010;45:1198–1202.

Abdullah S, Vaithianathan R, Rajendiran K, Santhanam R. Randomized clinical trial of single versus three doses of cefazolin as prophylaxis for nonperforated acute appendicitis. IJCRR 2012;4:124–30.

Ravari H, Jangjoo A, Motamedifar J, Moazzami K. Oral metronidazole as antibiotic prophylaxis for patients with nonperforated appendicitis. Clin Exp Gastroenterol 2011;4:273–6

Mui LM, Ng CS, Wong SK, et al. Optimum duration of prophylactic antibiotics in acute nonperforated appendicitis. ANZ J Surg 2005; 75: 425-8.

Le D, Rusin W, Hill B, Langell J. Postoperative antibiotics use in non perforated appendicitis. Am J Surg 2009; 198: 748-52.

Coakley BA, Sussman ES, Wolfson TS, et al. Postoperative antibiotics correlate with worse outcomes after appendectomy for nonperforated appendicitis. J Am Coll Surg 2011; 213: 778-83.

Hussain MI, Mohammed KA, Hamad HA-Q, Mohammed HA. Role of Postoperative Antibiotics after Appendectomy in Non-Perforated Appendicitis. J Coll Physicians Surg Pak 2012; 22: 756-9.

Al-Mefreji KA. Antibiotics prophylaxis in non-perforated appendicitis: a prospective study. Al-Kindy Col Med J 2006; 3: 49-51.

Ravari H, Jangjoo A, Motamedifar J, Moazzami K. Oral metronidazole as antibiotic prophylaxis for patients with nonperforated appendicitis. Clin Exp Gastroenterol 2011; 4: 273-6.

Muhammad Salman Rafiq, MahMuneer Khan, Attaullah Khan, Hizbullah Jan et al.Evaluation of postoperative antibiotics after non-perforated appendectomy:JPMA 65: 815; 2015