Post operative sepsis due to antibiotic failure in gangrenous or perforated appendicitis

Seventy-two adult patients with peritonitis, caused by gangrenous or perforated appendicitis, received 80 mg of gentamicin and 500 mg of metronidazole, 8 hourly for 5 days. Postoperative wound infection occurred in 16 [22%] of these patients. Changing the antibiotic therapy, after the culture result became available did not influence the clinical outcome. Deep seated infections occurred in 3 patients, 2 of whom had pelvic and one retrocaecal abscess. Escherichia coli was the commonest organism isolated in 9 patients in 6 of whom it was resistant to gentamicin. No signs or symptoms of nephrotoxicity or ototoxicity developed during use of gentamicin. Although the combination of gentamicin and metronidazole is safe in the prevention and treatment of wound infection, the failure rate in appendicectomy for perforated or gangrenous appendicitis is unacceptably high. This data shows that a reconsideration of the antibiotic policy in patients with perforated and gangrenous appendicitis is indicated