Revention Of Wound Sepsis After Appendicectomy:

Mohamed Mohamed Amin Saleh

The value of Metronidazole in the prevention of wound sepsis after appendicectomy was assessed in a prospective, controlled, randomised, clinical trial Involving ninetypatients. Thirty patients were in the control group where no prophylaxis was given; thirty were treated by prophylactic syrstemic Penicillin-Streptomycin and thirty were giVen pro-phylactic Yetronif-tzoleThe trial also included an assessment of the value of delayed primary wound closure in gangrenous and perforated appendices. Ten patients were included in the delayed closure group and in 30 patients the wound was closedprimarily . In both the control and the ,antibiotic group wound sepsis occurred in 33% of patients. This was reduced significantly to 13% in the Metronidazole grouo. The results were even more evident in patients with gangrenous or perforated appendices where wound sepsis in the control group occurred in 6 out of 7 patients. In the antibiotic group it occurred in 5 out of 6 patients and in the Metronidazole group in only 1 out of 7 patients. In patients with normal cr inflamed appendices there was no statistical difference between the control, antibiotic and Metropidazole group .Delayed primary closure was also effective in reducing wound sepsis, only 4 out of 10 patients (with gangrenous or Perforated appendtices) had wend sepsis compared to 8 out of 10 patients in the primary closure groupIt is concluded that Netronidawle in the regimen used in this trial, where pre-operative medication of 1 g. Metro. nidazole was given rectally followed by 1 g. every 8 hours until oral feeding is allowed, when Metronidazole was given in 250 mg. tablets three times daily to the end of the seventh day, is effective in reducing wound sepsis, particularly in gangrenous or perforated append ices . Delayed primary wound closure showed a statistically significant reduction of wound sepsis rind is recommended in all patients with gangrenous or perforated appendices . The debatable statement is whether it is improper to withhold Netronidazole prophylaxis in patients subjected to appendicectomy, The possibility of rendering this vainable. drug useless by the emergence of resistant, strains in appas rantly normal and slightly inflamed appendices macs one hesitate to use it in every patient but to limit its use in gangcmous and perforated oasesThe second point is that Netronidazole is only effective against anaerobes, which are the most common causative organisms, However, aerobic wound infections still occur and a local antiseptic agent as Povidoneiodine shich is effective against all organisms is a possible acceptablealternative and there appears to be a place for a controlled trial comparing Netronidazole with dry powder povidone., iodine cr with the local instillation, in the tound of a broad-spectrum antibiotic effective ’against anaerobes as chloramphenicol or Lincomycin .