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The effect of postoperative antibiotic administration on the incidence of infectious complications after cholecystectomy

About 90% of cases of acute calcareous cholecystitis are mild, i.e. characterized by a mild (grade I) or moderately severe (grade II) course. Although perioperative antibiotic prophylaxis is standardized for acute calcium cholecystitis (i.e. prophylactic antibiotics before and during surgery), there is still evidence that postoperative antibiotics are appropriate.

In order to confirm or refute the need for postoperative administration of antibiotics, a randomized study was conducted on the efficacy of the use of amoxicillin / clavulanate after cholecystectomy.

The study included 414 patients with acute calcium cholecystitis of severity I or II who were treated in 17 medical centers from May 2010 to August 2012. All patients received amoxicillin / clavulanate at a dose of 2 g 3 times daily before surgery and once after surgery and were then randomized to participate in an open study, in which one group was not prescribed an antibiotic, and the second group received amoxicillin / clavulanate at the same dose as before surgery for 5 days.

During the study, the incidence of postoperative infections was recorded (both in the area of surgery and long-term) during the 4 weeks of the follow-up period.

When analyzing all the patients who underwent an intervention (ITT population, n = 414), it was found that the incidence of postoperative infections was 17% (35 out of 207) in the group without not receiving antibiotics after surgery, and 15% (31 of 207) in the group to which amoxicillin / clavulanate was prescribed within 5 days of surgery (absolute difference 1.93%; 95% confidence interval % -8.98% - 5.12%). When analyzed according to protocol (n = 338), this indicator was 13% in the two groups (absolute difference of 0.3%; 95% confidence interval -5.0% - 6.3%).

It has been found that not prescribing antibiotics after surgery does not lead to a deterioration in results compared to the use of antibiotics. In a cultural study of bile in 60.9% of cases, negative results were obtained, i.e. no causally significant pathogen was identified. The severity of the results / surgical complications was comparable in the two groups according to the Clavien-Dindo classification: in the group who did not receive antibiotics, 195 patients (94.2%) had a grade 0 and only 2 patients ( 0.97%) had complications attributed to degree III-IV. In the group to which antibiotics were prescribed, 182 patients (87.8%) had a degree of complications 0-I and in 4 patients (1.93%), the complications were classified in degree III-IV.

Thus, in patients with mild and moderate forms of acute calcium cholecystitis, only perioperative antibiotic prophylaxis is sufficient, because the study clearly demonstrated the lack of efficacy of amoxcillin / clavulanate after surgery, that is, that is, the use of antibiotics only before and during surgery does not increase the frequency of postoperative infectious complications.