Prophylactic antibiotics (appendicectomy)

If the diagnosis is suspected appendicitis, the patient should be given broad-spectrum antibiotics. Many agents have been tried:

• cephalosporin and metronidazole:
  • widely favoured
  • metronidazole suppository can be given with pre-medication e.g. 1g adults or 500mg children
• ampicillin and clavulanic acid
• cefoxitin
• aminoglycoside and metronidazole or clindamycin

The timing of prophylaxis is vital. It should be given at induction. The duration of therapy is dependent on the operative findings. Generally, only a couple of doses of antibiotics are necessary for early, uncomplicated appendicitis. Those with a perforated or necrotic appendix or an appendix mass should be given a more prolonged course e.g. 7-10 days.