A retrospective study showing the misuse of prophylactic antibiotics in patients undergoing appendectomy and cholecystectomy

Objective: The aim of this study was to assess the appropriateness of antibiotic prophylaxis in a sample of patients undergoing appendectomy and cholecystectomy. Background: Inappropriate use of antibiotics occurs in all medical specialties; incorrect antibiotic prophylaxis for surgical procedures has been shown to be one of the most serious misuses of these drugs. Methods: A retrospective review of antibiotic prophylaxis was conducted in 7 departments of surgery in an urban, public, university-affilliated, 2000-bed Italian general hospital. Prophylaxis was considered appropriate if it was performed at the induction of anesthesia and consisted of a single intravenous injection of an antibiotic recommended by the guidelines or, according to a less stringent criterion, if limited to 24-hour coverage. The charts of 138 patients who underwent surgery for appendectomy (n = 55) or cholecystectomy (n = 83) in 1997 were randomly selected for review from a total of 676 patients undergoing the procedures that year. Results: A total of 5 antibiotics were used for prophylaxis in appendectomy and 7 in cholecystectomy. Among the patients given antibiotics prophylactically, these drugs were used inappropriately in 63.6% of patients who underwent appendectomy and in 75% of those who underwent cholecystectomy. Reasons for inappropriateness were an excessive duration of treatment, incorrect timing of administration, inadequate antibacterial spectrum of the drug used, and unnecessary combination of 2 antibiotics. Conclusions: In this Italian general hospital, prophylactic use of antibiotics was inappropriate in the majority of patients undergoing appendectomy or cholecystectomy.