Comparing single dose versus multiple doses antibiotic prophylaxis in preventing surgical site infections following open appendicectomy for uncomplicated appendicitis

Abstract

Background: Acute appendicitis is the leading cause of acute surgical abdomen. Studies have shown that
a single dose of antibiotics is as effective as multiple doses in preventing surgical site infections (SSI)
after appendectomy, with advantages such as cost savings, fewer adverse reactions, and reduced risk of
antibiotic resistance. Despite these benefits, multiple doses are still commonly used. This study compared
the efficacy of single-dose versus multiple-dose antibiotic prophylaxis in preventing SSI after open
appendectomy for uncomplicated appendicitis.
Methodology: A one-year prospective study was conducted at the university of Benin teaching hospital
(UBTH), Benin City, involving 62 adult patients with uncomplicated appendicitis. A total of 76 patients
were initially recruited, but after histological evaluation, 62 patients were analyzed, 29 received a single
dose of antibiotics, and 33 received multiple doses following the exclusion of the negative
appendicectomies. All patients were given intravenous 1.5 g cefuroxime and 500 mg metronidazole at
anesthesia induction, with the multiple-dose group receiving two additional doses. Outcomes assessed
included SSI occurrence, cost of antibiotics, and SSI management costs.
Results: SSI rates were similar between groups (3.5% vs. 3.0%), but the cost of multiple-dose regimens
was over twice that of single-dose. Side effects were more frequent with multiple doses. Both SSI cases
were superficial and associated with higher BMI.
Conclusion: Single-dose antibiotic prophylaxis is equally effective, more economical, and safer than
multiple doses.