Antibiotics

Broad-spectrum antibiotics play an important role in the management of acute appendicitis. Although antibiotics have been found effective alone in treating acute appendicitis,35 appendectomy remains the standard of care. As a rule, antibiotics should not be given to a patient with undiagnosed abdominal pain, to prevent inadvertent suppression of an evolving clinical presentation. In patients with uncomplicated appendicitis, antibiotics have been found to decrease the incidence of postoperative wound infections. In patients with perforation, early antibiotics have been shown to decrease postoperative abscess formation. 3 37 Antibiotics are most effective when given prior to surgery and should cover anaerobic flora, enterococci, and gram-negative intestinal flora. A common triple-coverage antibiotic combination is metronidazole, ampicillin, and gentamicin. Single coverage with cefoxitin or cefotetan is also an option. 3638

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