Appendicectomy
Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis) and the general principles of surgical antibiotic prophylaxis for abdominal surgery. See Appendicectomy procedures and their requirement for surgical antibiotic prophylaxis for the recommendations for surgical prophylaxis for appendicectomy.
If antibiotic treatment for appendicitis has been started preoperatively, it is not necessary to give additional antibiotic prophylaxis. However, adjust the timing of the treatment dose to achieve adequate plasma and tissue concentrations at the time of surgical incision and for the duration of the procedure. See Surgical antibiotic prophylaxis for patients receiving treatment for established infection.
For patients with acute uncomplicated appendicitis, stop antibiotic therapy immediately after appendicectomy. For patients with complicated appendicitis (perforated appendicitis or appendiceal abscess), antibiotic therapy is continued for 4 days after adequate surgical control of the source of infection has been achieved; see Acute appendicitis for advice on intravenous to oral switch.
For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.
|
Procedures |
Is surgical antibiotic prophylaxis indicated? |
|---|---|
|
all appendicectomy procedures, including laparoscopic appendicectomy |
YES; however, if the patient is being treated with antibiotic therapy for appendicitis, additional antibiotic prophylaxis is not required (see above) |
If the patient is not receiving antibiotic treatment for appendicitis, for prophylaxis, use:
metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, within the 120 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed surgical prophylaxis, appendicectomy metronidazole
PLUS
cefazolin 2 g (child: 30 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, appendicectomy cefazolin
As an alternative, cefoxitin may be used as a single drug; however, its activity against anaerobes is inferior to the regimen above. It also requires frequent redosing (every 2 hours). Use:
cefoxitin 2 g (child: 40 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, appendicectomy cefoxitin
For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, the above regimens are suitable. See also Surgical antibiotic prophylaxis for patients with a penicillin or cephalosporin allergy.
For patients with immediate severe or delayed severe hypersensitivity to penicillins, use:
metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, within the 120 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed metronidazole
PLUS
gentamicin (adult and child) 2 mg/kg up to 180 mg intravenously over 3 to 5 minutes, within the 120 minutes before surgical incision12; intraoperative redosing is unlikely to be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, appendicectomy gentamicin