human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 544 children operated upon for uncomplicated appendicitis were r and omised into three groups . Group I received no antibiotics , patients in Group II were administered one single pre-operative dose of metronidazole ( 10 mg/kg ) and patients in Group III received both both metronidazole ( 20 mg/kg ) and cefuroxime ( 50 mg/kg ) in a single preoperative dose . The rate of infectious complications in Group I was 6.3 % but only 2.1 and 2.3 in Groups II and III , respectively . Among patients with a normal appendix or patients with simple appendicitis there was no difference in the rate of post-operative infections between the three different groups . However , in patients with gangrenous appendicitis the rate of postoperative infections was significantly lower in the two groups who received preoperative antibiotics ( 1.8 % and 3.0 % respectively ) than in the group receiving no prophylactic antibiotics ( infection rate 14 % ) . It is concluded that a single preoperative dose of metronidazole significantly decreases the rate of postoperative infectious complications in children with appendicitis . No further improvement could be demonstrated if cefuroxime against aerobic organisms was added The conventional treatment of acute appendicitis is appendectomy followed by intravenous ( IV ) antibiotics until intraabdominal infection has resolved . It is controversial as to whether it is efficacious to add a course of oral antibiotics after cessation of IV antibiotics . All consenting patients who presented to Kern Medical Center between October 2000 and June 2003 with acute appendicitis were entered into the study . Perforated/gangrenous appendicitis was equally represented in the two study arms . After appendectomy , and when IV antibiotics were ready to be discontinued , patients were r and omized to receive a 7-day outpatient course of either placebo ( Group 1 ) or oral antibiotics ( Group 2 ) . Patients were monitored for infectious complications for a minimum of 3 months , and there was no statistical difference ( 11.5 % in Group 1 vs 12.1 % in Group 2 , P = 0.61 ) . The data suggest that adding a course of outpatient oral antibiotics  , after completing a course of IV antibiotics , does not decrease postoperative infectious complications in appendicitis patients A series of 102 consecutive patients undergoing appendectomy through an incision in the right iliac fossa entered a prospect i ve r and omized trial to compare the effects of a 2 gram intravenous bolus dose of cefam and ole with a control study . No differences occurred in the incidence of wound infection in the two groups . We conclude that there is no place for a single preoperative dosage of cefam and ole in the management of appendicitis A r and omized controlled trail in 374 patients requiring emergency appendicectomy  to determine the value of topical ampicillin and antiseptic solution of chlorhexidine and cetyl trimethyl ammonium bromide ( Savlon ) in preventing wound infection is reported . The application of 1 g of ampicillin powder to the wound significantly reduced wound infection in perforated appendicitis , but not in unperforated appendicitis . Wound irrigation with 1 per cent cetyl trimethyl ammonium bromide was ineffective in preventing wound infection in all grade s of appendicitis . When wound contamination is difficult to avoid , as in perforated appendicitis , topical ampicillin should be used to reduce the rate of wound infection This study sought to determine in a district general hospital ( a ) the frequency and nature of bacterial contamination at operation , ( b ) the incidence of consequent infection and ( c ) the prophylactic effect , if any , of inter‐parietal povidone‐iodine against postoperative wound infection A total of 133 children , aged 16 months to 15 years ( mean 6.7 years ) , with presumptive acute appendicitis , was included in a double-blind , placebo-controlled trial of the short-term ( 72 hour ) use of metronidazole suppositories as prophylaxis against post-operative infection . There was no significant difference in the incidence or severity of wound infection or post-operative intra-abdominal sepsis between the metronidazole-treated and placebo groups . It is suggested that intra-rectal metronidazole , when used exclusively , is not sufficient for effective prophylaxis for appendicitis in childhood A total of 223 consecutive suspected appendicitis patients were treated preoperatively with parenteral tinidazole or physiological saline ( control group ) . An infusion of 500 mg tinidazole was given to 110 patients over 30 minutes beginning about 30 minutes before the start of the operation , the control group comprised 111 patients .  Postoperative infections were diagnosed in three patients in the group receiving tinidazole ( 3 % ) and in 17 patients in the control group ( 15 % ) . The difference was statistically significant . There were no side-effects due to the drugs . Tinidazole appears to be well suited to the prophylaxis of post-appendicectomy infections A controlled trial of intraperitoneal noxytiolin ( Noxiflex ) solution in patients with peritonitis due to perforafed appendicitis is reported . No significant difference was found in the incidence of complications between the treated and a control group , raising doubts as to whether this substance is of value when used intraperitoneally in peritonitis The authors question the need to give prophylactic antibiotics perioperatively in all cases of acute appendicitis without perforation to reduce the rate of wound infection . A retrospective study of 82 patients showed a wound infection rate of 4.8 % ; 3 of 53 patients who did not receive antibiotics  had a wound infection compared with 1 of 29 patients who received antibiotics . A prospect i ve double-blind clinical trial was performed comparing the results of perioperative administration of cefam and ole and placebo . One of 21 patients who received the placebo had a wound infection ; none of the 21 patients given cefam and ole had infection . Thus , the authors conclude that , although reports in the literature suggest that antibiotics given perioperatively decrease the rate of wound infection  in acute appendicitis without perforation , the incidence of such infection is too low to warrant routine administration . They suggest that such antibiotic use be reserved for those suspected of having more serious disease A prospect i ve r and omized clinical trial was performed to determine the efficiency of single-dose antibiotic prophylaxis in preventing septic complications after appendectomy . The infection rate increased significantly in the control group without antibiotic prophylaxis ( 9.3 % to 20.3 % ) . Older patients with severe appendicitis had more advantages from the prophylaxis than younger ones . We have suggested to perform antibiotic prophylaxis individually only in those patients with high risk of septic complications after appendectomy Two hundred and fifty patients were admitted to a prospect i ve r and omized trial of single dosage prophylaxis against wound infection after appendicectomy . There were 12 exclusions , 72 patients received placebo , 81 received 600 mg i.m . clindamycin phosphate and 85 received 1 g i.m . cefazolin sodium , the agent being given in the anaesthetic room . Clindamycin produced a significant reduction in the overall rate of wound infection from 33 per cent in the controls to 17 per cent . In cases with a gangrenous or perforated appendix the infection rate in controls was 78 per cent ; this was reduced to 44 per cent by a single dose of clindamycin Prospect i ve investigation of consecutive children suffering from non-perforating appendicitis indicated that metronidazole prophylaxis significantly reduces the risk of postoperative wound sepsis regardless of the method of closure . However , in view of the advantages of subcuticular polyglycolic acid this must be regarded as the method of closure of choice in non-perforating appendicitis in children A prospect i ve , r and omized , double-blind study on the effect of cephaloridine prophylaxis in the surgical management of appendicitis was performed . Of the 139 patients studied , 70 received cephaloridine and 69 received placebo prophylaxis . Both groups of patients were well matched with regard to age , sex , operative findings , and bacteria isolated at operation . Postoperative wound infections were detected in 11.6 % of placebo-treated patients and in 1.4 % of cephaloridine-treated patients ( P less than .02 ) . Prophylactic treatment with cephaloridine of patients undergoing surgery for uncomplicated appendicitis result ed in a perceptible reduction in the rate of postoperative wound infection Post-appendicectomy sepsis still causes considerable morbidity and prolongs hospital stay . A large amount of recent work has gone into attempts to reduce such problems using various topical and systemic agents in differing regimes , with wide variation in their results . The aim of our study was to examine further the effectiveness of those different lines of prophylaxis against placebo in reducing post-appendicectomy sepsis . It is a comparative study of 400 cases of uncomplicated appendicitis operated upon by three senior Surgeons . The cases were allocated r and omly in equal number to four groups according to the prophylactic antibiotic regime used : ( a ) Placebo ; ( b ) Metronidazole alone ; ( c ) Metronidazole and cefazolin ; ( d ) Metronidazole and tobramycin . Antibiotics were given preoperatively with premedication and continued postoperatively for three days . The patients were checked for signs of sepsis during hospital stay and weekly up to a minimum of four weeks after discharge . They were also compared as far as their hospital stay is concerned . The conclusion of this study is that a combination of an antibiotic aim ed at aerobes ( cefazolin or tobramycin ) with another aim ing at anaerobes ( metronidazole ) is the best prophylactic regime against post-appendicectomy sepsis A prospect i ve , r and omized , clinical study was carried out in 188 patients undergoing appendicectomy or colorectal surgery  to test the efficacy of prophylactic , parenterally-administered antibiotics in the prevention of infection . The results show the effectiveness of the association gentamicin-metronidazole  ( 9.4 % of infections ) , compared to the control group with no antibiotics ( 39.1 % of infections ) , X2 = 14.1 ; P less than 0.001 ) In a r and omized controlled trial of the use of a single intravenous dose of gentamicin sulfate and clindamycin phosphate used intraoperatively during emergency abdominal surgery , the overall incidence of postoperative wound infection was reduced from 32.3 % to 10.4 % . Significant reduction in wound infection occurred in the study group compared with control subjects irrespective of the underlying pathologic lesion . No side effects of the use of antibiotics were noted . The policy of antibiotic prophylaxis in emergency surgery seems to be of particular benefit in elderly patients In a series of 762 general surgical wounds 376 were selected at r and om to receive three parenteral doses of cephaloridine and 386 remained as untreated controls . In all types of operation , with the exception of wounds in the lower extremities associated with arterial surgery , the rate of wound infection was lowered by the prophylactic use of cephaloridine . The results were statistically significant for total wounds , clean wounds , total contaminated wounds , and contaminated wounds other than in colorectal surgery . We therefore recommend the routine use of three doses of cephaloridine The efficacy of a single 500 mg intravenous intra-operative dose of metronidazole in the prevention of postoperative wound infection , following appendicectomy for acute mural appendicitis , was studied in a prospect i ve r and omized placebo controlled trial . Fourteen of the 96 patients ( 14.6 % ) in the metronidazole group and 13 of the 94 in the  placebo  group ( 13.8 % ) developed postoperative wound infection . Late sepsis was noted in 4 out of the 96 patients in the metronidazole group and in one of the 94 patients in the placebo group . This study suggests that a single intra-operative dose of metronidazole dose not reduce the incidence of postoperative wound infection following appendicectomy for acute mural appendicitis In the search for an appropriate antibiotic to reduce the rate of  postoperative wound infection in patients with acute appendicitis , we have r and omized 150 patients preoperatively in a prospect i ve 3-arm study . The operation technique was st and ardized for all patients and involved the use of plastic wound protectors . Bacterial contamination was documented by 3 swabs taken during operation . In 2 arms , patients received short-term adjuvant prophylaxis with either cefazolin or clindamycin/tobramycin . The third arm served as a control . Wound contamination ws proven in 33 % of all cases but only 4 % developed a real wound infection . The rate of infection was almost identical in all groups , without a statistically significant difference in the chi2 test . It is concluded that wound infection after appendectomy can not be prevented by prophylactic use of antibiotics . Careful operation technique with local protective steps is quite sufficient . Antibiotics should therefore be reserved for special indications One hundred patients undergoing appendicectomy through a right iliac f 
    Output:
    
agent
The outcome measures of the studies were : Wound infection , intra abdominal abscess , length of stay in hospital , and mortality .
The overall result is that the use of antibiotics is superior to placebo for preventing wound infection and intraabdominal abscess , with no apparent difference in the nature of the removed appendix .
Studies exclusively on children and studies examining topical application reported results in favour to the above , although the results were not significant .
Antibiotic prophylaxis is effective in the prevention of postoperative complications in appendectomised patients , whether the administration is given pre- , peri- or post-operatively , and could be considered for routine in emergency appendectomies
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 544 children operated upon for uncomplicated appendicitis were r and omised into three groups . Group I received no antibiotics , patients in Group II were administered one single pre-operative dose of metronidazole ( 10 mg/kg ) and patients in Group III received both both metronidazole ( 20 mg/kg ) and cefuroxime ( 50 mg/kg ) in a single preoperative dose . The rate of infectious complications in Group I was 6.3 % but only 2.1 and 2.3 in Groups II and III , respectively . Among patients with a normal appendix or patients with simple appendicitis there was no difference in the rate of post-operative infections between the three different groups . However , in patients with gangrenous appendicitis the rate of postoperative infections was significantly lower in the two groups who received preoperative antibiotics ( 1.8 % and 3.0 % respectively ) than in the group receiving no prophylactic antibiotics ( infection rate 14 % ) . It is concluded that a single preoperative dose of metronidazole significantly decreases the rate of postoperative infectious complications in children with appendicitis . No further improvement could be demonstrated if cefuroxime against aerobic organisms was added The conventional treatment of acute appendicitis is appendectomy followed by intravenous ( IV ) antibiotics until intraabdominal infection has resolved . It is controversial as to whether it is efficacious to add a course of oral antibiotics after cessation of IV antibiotics . All consenting patients who presented to Kern Medical Center between October 2000 and June 2003 with acute appendicitis were entered into the study . Perforated/gangrenous appendicitis was equally represented in the two study arms . After appendectomy , and when IV antibiotics were ready to be discontinued , patients were r and omized to receive a 7-day outpatient course of either placebo ( Group 1 ) or oral antibiotics ( Group 2 ) . Patients were monitored for infectious complications for a minimum of 3 months , and there was no statistical difference ( 11.5 % in Group 1 vs 12.1 % in Group 2 , P = 0.61 ) . The data suggest that adding a course of outpatient oral antibiotics  , after completing a course of IV antibiotics , does not decrease postoperative infectious complications in appendicitis patients A series of 102 consecutive patients undergoing appendectomy through an incision in the right iliac fossa entered a prospect i ve r and omized trial to compare the effects of a 2 gram intravenous bolus dose of cefam and ole with a control study . No differences occurred in the incidence of wound infection in the two groups . We conclude that there is no place for a single preoperative dosage of cefam and ole in the management of appendicitis A r and omized controlled trail in 374 patients requiring emergency appendicectomy  to determine the value of topical ampicillin and antiseptic solution of chlorhexidine and cetyl trimethyl ammonium bromide ( Savlon ) in preventing wound infection is reported . The application of 1 g of ampicillin powder to the wound significantly reduced wound infection in perforated appendicitis , but not in unperforated appendicitis . Wound irrigation with 1 per cent cetyl trimethyl ammonium bromide was ineffective in preventing wound infection in all grade s of appendicitis . When wound contamination is difficult to avoid , as in perforated appendicitis , topical ampicillin should be used to reduce the rate of wound infection This study sought to determine in a district general hospital ( a ) the frequency and nature of bacterial contamination at operation , ( b ) the incidence of consequent infection and ( c ) the prophylactic effect , if any , of inter‐parietal povidone‐iodine against postoperative wound infection A total of 133 children , aged 16 months to 15 years ( mean 6.7 years ) , with presumptive acute appendicitis , was included in a double-blind , placebo-controlled trial of the short-term ( 72 hour ) use of metronidazole suppositories as prophylaxis against post-operative infection . There was no significant difference in the incidence or severity of wound infection or post-operative intra-abdominal sepsis between the metronidazole-treated and placebo groups . It is suggested that intra-rectal metronidazole , when used exclusively , is not sufficient for effective prophylaxis for appendicitis in childhood A total of 223 consecutive suspected appendicitis patients were treated preoperatively with parenteral tinidazole or physiological saline ( control group ) . An infusion of 500 mg tinidazole was given to 110 patients over 30 minutes beginning about 30 minutes before the start of the operation , the control group comprised 111 patients .  Postoperative infections were diagnosed in three patients in the group receiving tinidazole ( 3 % ) and in 17 patients in the control group ( 15 % ) . The difference was statistically significant . There were no side-effects due to the drugs . Tinidazole appears to be well suited to the prophylaxis of post-appendicectomy infections A controlled trial of intraperitoneal noxytiolin ( Noxiflex ) solution in patients with peritonitis due to perforafed appendicitis is reported . No significant difference was found in the incidence of complications between the treated and a control group , raising doubts as to whether this substance is of value when used intraperitoneally in peritonitis The authors question the need to give prophylactic antibiotics perioperatively in all cases of acute appendicitis without perforation to reduce the rate of wound infection . A retrospective study of 82 patients showed a wound infection rate of 4.8 % ; 3 of 53 patients who did not receive antibiotics  had a wound infection compared with 1 of 29 patients who received antibiotics . A prospect i ve double-blind clinical trial was performed comparing the results of perioperative administration of cefam and ole and placebo . One of 21 patients who received the placebo had a wound infection ; none of the 21 patients given cefam and ole had infection . Thus , the authors conclude that , although reports in the literature suggest that antibiotics given perioperatively decrease the rate of wound infection  in acute appendicitis without perforation , the incidence of such infection is too low to warrant routine administration . They suggest that such antibiotic use be reserved for those suspected of having more serious disease A prospect i ve r and omized clinical trial was performed to determine the efficiency of single-dose antibiotic prophylaxis in preventing septic complications after appendectomy . The infection rate increased significantly in the control group without antibiotic prophylaxis ( 9.3 % to 20.3 % ) . Older patients with severe appendicitis had more advantages from the prophylaxis than younger ones . We have suggested to perform antibiotic prophylaxis individually only in those patients with high risk of septic complications after appendectomy Two hundred and fifty patients were admitted to a prospect i ve r and omized trial of single dosage prophylaxis against wound infection after appendicectomy . There were 12 exclusions , 72 patients received placebo , 81 received 600 mg i.m . clindamycin phosphate and 85 received 1 g i.m . cefazolin sodium , the agent being given in the anaesthetic room . Clindamycin produced a significant reduction in the overall rate of wound infection from 33 per cent in the controls to 17 per cent . In cases with a gangrenous or perforated appendix the infection rate in controls was 78 per cent ; this was reduced to 44 per cent by a single dose of clindamycin Prospect i ve investigation of consecutive children suffering from non-perforating appendicitis indicated that metronidazole prophylaxis significantly reduces the risk of postoperative wound sepsis regardless of the method of closure . However , in view of the advantages of subcuticular polyglycolic acid this must be regarded as the method of closure of choice in non-perforating appendicitis in children A prospect i ve , r and omized , double-blind study on the effect of cephaloridine prophylaxis in the surgical management of appendicitis was performed . Of the 139 patients studied , 70 received cephaloridine and 69 received placebo prophylaxis . Both groups of patients were well matched with regard to age , sex , operative findings , and bacteria isolated at operation . Postoperative wound infections were detected in 11.6 % of placebo-treated patients and in 1.4 % of cephaloridine-treated patients ( P less than .02 ) . Prophylactic treatment with cephaloridine of patients undergoing surgery for uncomplicated appendicitis result ed in a perceptible reduction in the rate of postoperative wound infection Post-appendicectomy sepsis still causes considerable morbidity and prolongs hospital stay . A large amount of recent work has gone into attempts to reduce such problems using various topical and systemic agents in differing regimes , with wide variation in their results . The aim of our study was to examine further the effectiveness of those different lines of prophylaxis against placebo in reducing post-appendicectomy sepsis . It is a comparative study of 400 cases of uncomplicated appendicitis operated upon by three senior Surgeons . The cases were allocated r and omly in equal number to four groups according to the prophylactic antibiotic regime used : ( a ) Placebo ; ( b ) Metronidazole alone ; ( c ) Metronidazole and cefazolin ; ( d ) Metronidazole and tobramycin . Antibiotics were given preoperatively with premedication and continued postoperatively for three days . The patients were checked for signs of sepsis during hospital stay and weekly up to a minimum of four weeks after discharge . They were also compared as far as their hospital stay is concerned . The conclusion of this study is that a combination of an antibiotic aim ed at aerobes ( cefazolin or tobramycin ) with another aim ing at anaerobes ( metronidazole ) is the best prophylactic regime against post-appendicectomy sepsis A prospect i ve , r and omized , clinical study was carried out in 188 patients undergoing appendicectomy or colorectal surgery  to test the efficacy of prophylactic , parenterally-administered antibiotics in the prevention of infection . The results show the effectiveness of the association gentamicin-metronidazole  ( 9.4 % of infections ) , compared to the control group with no antibiotics ( 39.1 % of infections ) , X2 = 14.1 ; P less than 0.001 ) In a r and omized controlled trial of the use of a single intravenous dose of gentamicin sulfate and clindamycin phosphate used intraoperatively during emergency abdominal surgery , the overall incidence of postoperative wound infection was reduced from 32.3 % to 10.4 % . Significant reduction in wound infection occurred in the study group compared with control subjects irrespective of the underlying pathologic lesion . No side effects of the use of antibiotics were noted . The policy of antibiotic prophylaxis in emergency surgery seems to be of particular benefit in elderly patients In a series of 762 general surgical wounds 376 were selected at r and om to receive three parenteral doses of cephaloridine and 386 remained as untreated controls . In all types of operation , with the exception of wounds in the lower extremities associated with arterial surgery , the rate of wound infection was lowered by the prophylactic use of cephaloridine . The results were statistically significant for total wounds , clean wounds , total contaminated wounds , and contaminated wounds other than in colorectal surgery . We therefore recommend the routine use of three doses of cephaloridine The efficacy of a single 500 mg intravenous intra-operative dose of metronidazole in the prevention of postoperative wound infection , following appendicectomy for acute mural appendicitis , was studied in a prospect i ve r and omized placebo controlled trial . Fourteen of the 96 patients ( 14.6 % ) in the metronidazole group and 13 of the 94 in the  placebo  group ( 13.8 % ) developed postoperative wound infection . Late sepsis was noted in 4 out of the 96 patients in the metronidazole group and in one of the 94 patients in the placebo group . This study suggests that a single intra-operative dose of metronidazole dose not reduce the incidence of postoperative wound infection following appendicectomy for acute mural appendicitis In the search for an appropriate antibiotic to reduce the rate of  postoperative wound infection in patients with acute appendicitis , we have r and omized 150 patients preoperatively in a prospect i ve 3-arm study . The operation technique was st and ardized for all patients and involved the use of plastic wound protectors . Bacterial contamination was documented by 3 swabs taken during operation . In 2 arms , patients received short-term adjuvant prophylaxis with either cefazolin or clindamycin/tobramycin . The third arm served as a control . Wound contamination ws proven in 33 % of all cases but only 4 % developed a real wound infection . The rate of infection was almost identical in all groups , without a statistically significant difference in the chi2 test . It is concluded that wound infection after appendectomy can not be prevented by prophylactic use of antibiotics . Careful operation technique with local protective steps is quite sufficient . Antibiotics should therefore be reserved for special indications One hundred patients undergoing appendicectomy through a right iliac f 
    Output:
    