Combined topical povidone-iodine and systemic antibiotics in postappendicectomy wound sepsis

Abstract

Three hundred and fifteen patients with appendicitis were randomized into two groups. One group received pre-operative systemic gentamicin and metronidazole while the other gruop received 1 per cent topical povidone-iodine solution in addition to the antibiotics. For early appendicitis including normal and acutely inflamed appendices, only one dose of antibiotics was used. The postoperative wound sepsis was very low in both groups of patients and there was no statistical difference between them. For late appendicitis including gangrenous and perforated appendices, the antibiotics were continued for 7 days. Eight out of 51 patients who had the topical agent developed wound sepsis compared with one out of 52 patients who received no topical agent. This difference is statistically significant (P=0.03). All wound infections presented within 2 weeks of operation and were deep. Povidone-iodine, 1 per cent, adversely affects the wound infection rate in late appendicitis and should not be used.