A COMPARATIVE STUDY ON ROLE OF METRONIDAZOLE IN SURGICAL MANAGEMENT OF ACUTE SIMPLE VERSUS ACUTE COMPLICATED APPENDICITIS
Main Article Content
Keywords
Abstract
Background: Although appendicectomy remains the standard and classical treatment for acute appendicitis, Metronidazole plays an important role in addition to antibiotics in controlling the infection was tested as an effective protocol. But comparison of its role in acute simple versus acute complicated Appendicitis was attempted in this study.
Aim of the study: To assess the effectiveness and outcomes of Metronidazole as an adjuvant to antibiotic treatment for acute simple and acute complicated appendicitis.
Materials: This was a prospective, controlled, non-randomized study involving 76 patients aged between 18 and 54 years. All clinically diagnosed with acute and acute complicated appendicitis. These patients were treated with appendicectomy and Metronidazole and antibiotic therapy, which included Metronidazole 500 mg IV thrice daily in addition to Ceftriaxone 1 gram twice daily administered three times daily for one week. Once the clinical improvement was observed, the treatment was switched to oral Metronidazole 200 mg thrice daily along with Cefixime 200 mg twice daily for 5 to 7 days. All the data related to the patients was analyzed using suitable statistical methods.
Results: Antibiotic treatment with Metronidazole was successful and feasible in 68/76 (89.74%) patients. In Group ‘A’ 22/38 patients (57.89%) sought medical attention within 24 hours of symptom onset, 10/38 patients (26.31%) presented between 24 and 48 hours. In group B 16/38 patients (42.10%) sought medical attention within 24 hours of symptom onset, 10/38 patients (26.31%) presented between 24 and 48 hours. There was statistical significance on Chi square test on the time of reporting to EMD and Alvarado score with p value 0.001 (p significant at less than 0.05).
Conclusion: Metronidazole for acute simple and acute complicated Appendicitis was safe, feasible, and effective option.
References
2. R. E. Andersson, “The natural history and traditional man- agement of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis,” World Journal of Surgery, vol. 31, no. 1, pp. 86–92, 2007.
3. N. D’Souza and K. Nugent, “Appendicitis,” BMJ Clinical Evidence, vol. 0408, 2014.
4. A. Alvarado, “A practical score for the early diagnosis of acute appendicitis,” Annals of Emergency Medicine, vol. 15, no. 5, pp. 557–564, 1986.
5. B. R. Neupane, S. R. Paudel, A. Shrestha, S. M. Bijukchhe, A. Bhattarai, and P. Subedi, “Management of acute abdomen: acute appendicitis,” Journal of Gandaki Medical College- Nepal, vol. 12, no. 2, pp. 3–9, 2019.
6. A. A. Malik and S. Bari, “Retracted article: conservative management of acute appendicitis,” Journal of Gastrointes- tinal Surgery, vol. 13, no. 5, pp. 966–970, 2009.
7. R. J. Mason, “Surgery for appendicitis: is it necessary?” Surgical Infections, vol. 9, no. 4, pp. 481–488, 2008.
8. J. Styrud, S. Eriksson, I. Nilsson et al., “Appendectomy versus antibiotic treatment in acute appendicitis: a prospective multicenter randomized controlled trial,” World Journal of Surgery, vol. 30, no. 6, pp. 1033–1037, 2006.
9. R. J. Manson, A. Moazzez, H. Sohn, N. Katkhouda et al., “Meta-analysis of randomized trials comparing antibiotic therapy with appendicectomy for acute uncomplicated (no abscess or phlegmon) appendicitis,” Surgical Infections, vol. 13, pp. 74–84, 2012.
10. J. Gillick, N. Mohanan, L. Das et al., “Laparoscopic appen- dicectomy after conservative management of appendix mass,” Pediatric Surgical International, vol. 24, no. 24, pp. 299–301,
11. 2008.
12. J. Hansson, U. Korner, A. Khorram-Manesh, A. Solberg, and K. Lundholm, “Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute ap- pendicitis in unselected patients,” British Journal of Surgery, vol. 96, no. 5, pp. 473–481, 2009.
13. M. Farahank, M. Talaei-Khoei, F. Gorouhi et al., “The alvarodo score and antibiotics therapy as a corporate protocol versus conventional clinic management: randomized con- trolled pilot study of approach to acute appendicitis,” American Journal of Emergency Medicine, vol. 25, pp. 850– 852, 2007.
14. Z. Yang, F. Sun, S. Ai, J. Wang, W. Guan, and S. Liu, “Meta- analysis of studies comparing conservative treatment with antibiotics and appendectomy for acute appendicitis in adult,” BMC Surgery, vol. 19, p. 110, 2019.
15. M. Kalan, D. Talbot, W. J. Cunliffe, and A. J. Rich, “Evaluation of modified Alvarado does score in the diagnosis of acute appendicitis: a prospective study,” Annals of The Royal College of Surgeons of England, vol. 76, pp. 418-419, 1994.
16. J. Shindoh, H. Niwa, K. Kawai et al., “Predictive factors for negative outcomes in initial non-operative management of suspected appendicitis,” Journal of Gastrointestinal Surgery, vol. 14, no. 2, pp. 309–314, 2010.
17. M. Podda, R. Andersson, M. Boermeester et al., “Do young patients with high clinical suspicion of appendicitis really need cross sectional imaging? Proceedings from a highly controversial debate among the experts’ panel of 2020 WSES Jerusalem guidelines,” Journal of Trauma and Acute Care Surgery, vol. 15, 2021.
18. K. E. Rollins, K. K. Varadhan, K. R. Neal, and D. N. Lobo, “Antibiotics versus appendicectomy for the treatment of uncomplicated acute appendicitis: an updated meta-analysis of randomised controlled trials,” World Journal of Surgery, vol. 40, no. 10, pp. 2305–2318, 2016.
19. S. D. Saverio, M. Mandrioli, A. Birindeli et al., “Single-incision laparoscopic appendectomy with a low-cost technique and surgical-glove port: “how to do it” with comparison of the outcomes and costs in a consecutive single-operator series of 45 cases,” Journal of the American College of Surgeons, vol. 222, no. 3, pp. e15–30, 2016.
20. K. Lui and L. Fogg, “Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systemic review and meta-analysis,” Surgery, vol. 150, pp. 673–683, 2011.
21. I. Wilms, D. de Hoog, D. de Visser, and H. M. Janzing, “Appendectomy versus antibiotic treatment for acute ap- pendicitis,” Cochrane Database of Systematic Reviews, vol. 11, no. 6, Article ID CD008359, 2011.
22. J. C. Harnoss, I. Zelienka, P. Probst et al., “Antibiotics versus surgical therapy for uncomplicated appendicitis,” Annals of Surgery, vol. 265, no. 5, pp. 889–900, 2017.
23. K. H. Mumtaz, A. H. Qays, and N. H. Laith, “Effectiveness of conservative management of uncomplicated acute appendi- citis: a single hospital based prospective study,” International Journal of Surgery, vol. 10, pp. 1–4, 2018.
24. S. D. Saverio, A. Sibilio, E. Giorgini, A. Biscardi et al., “The NOTA study (non operative treatment for acute appendicitis). Prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow- up of conservatively treated suspected appendicitis,” Annals of Surgery, vol. 260, no. 1, pp. 109–117, 2014.
25. K. Lundholm, J. Hansson-Assarsson, C. Engstrom, and B.-M. Iresjo, “Long-term results following antibiotic treat- ment of acute appendicitis in adult,” World Journal of Surgery, vol. 10, pp. 3987–3996, 2017.
26. D. S. Salomone, P. Mauro, and C. Fausto, “Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines,” World Journal of Emergency Surgery, vol. 15, no. 1, p. 27, 2020.
27. B. A. McCutcheon, D. C. Chang, L. P. Marcus et al., “Long- term outcomes of patients with nonsurgically managed un- complicated appendicitis,” Journal of the American College of Surgeons, vol. 218, no. 5, pp. 905–913, 2014.
28. Y. Tanaka, H. Uchida, H. Kawashima et al., “Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis,” Journal of Pediatric Surgery, vol. 50, no. 11, pp. 1893–1897, 2015.
29. P. Salminen, R. Tuominen, H. Paajanaen et al., “Five-year follow-up of antibiotic therapy for uncomplicated acute ap- pendicitis in the APPAC randomized clinical trial,” JAMA2018, vol. 320, no. 12, p. 125, 2018.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.