Research Article| Volume 47, ISSUE 3, P203-209, October 2003

Download started.


When should old therapies be abandoned? A modern look at old studies on topical ampicillin


      Objective. We sought to determine whether topical ampicillin can reduce the rate of wound infections in clean contaminated surgical wounds (appendectomy, colorectal surgery).
      Method. All randomized controlled trials examining the use of topical ampicillin in appendectomy and colorectal surgery published in English were identified via a Medline, Advanced Medline, and Cochraine Controlled Trials Register search and a meta-analysis performed.
      Results. Topical ampicillin vs. no antibiotic prophylaxis in clean contaminated wounds significantly reduced surgical wound infection rates (Odds Ratio (OR)=0.084, 95% CI, 0.04–0.16, P<0.0001). Topical ampicillin vs. no antibiotic prophylaxis in contaminated wounds also reduced surgical wound infection (OR=0.262, 95% CI, 0.14–0.51, P<0.0001). Topical ampicillin combined with systemic antibiotics vs. systemic antibiotics alone did not reduce surgical wound infection rate (OR=0.927, 95% CI, 0.27–1.72, P=0.90).
      Conclusion. Topical ampicillin significantly reduces the rate of surgical wound infections in clean contaminated surgery. A significant but smaller effect is seen in appendectomies where the appendix is gangrenous or perforated. Topical ampicillin did not confer any additional benefit when systemic antibiotics are used. While ampicillin may no longer be an effective agent, topical application of antibiotics is effective.
      Summary. A meta-analysis of studies using topical ampicillin for the prevention of infection in clean contaminated wound suggests that topical ampicillin is effective, but no incremental benefit is seen with systemic antibiotics.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Moylan J.A.
        The proper use of local antimicrobial agents in wounds.
        World J Surg. 1980; 4: 433-437
        • Wilson G.
        Infection Control in Clinical Practice. Bailliere Tindall, London1995
        • Baum M.L.
        • Anish D.S.
        • Chalmers T.C.
        • Sacks H.S.
        • Smith H.
        • Fagerstorm R.M.
        A survey of clinical trials of antibiotic prophylaxis in colon surgery: evidence against further use of no-treatment controls.
        N Engl J Med. 1981; 305: 795-799
        • Yalcin A.N.
        • Bakir M.
        • Bakici Z.
        • Dokmetas I.
        • Sabir N.
        Postoperative wound infections.
        J Hosp Infect. 1995; 29: 305-309
        • Casten D.F.
        • Nach R.J.
        • Spinzia J.
        An experimental and clinical study of the effectiveness of antibiotic wound irrigation in preventing infection.
        Surg Gynecol Obstet. 1964; 118: 783
        • Flemming M.
        • Mogens L.N.
        • Tage J.
        Intra-incisional antibiotics in laparotomy wounds.
        Dis Colon Rectum. 1984; 27: 72-75
        • Moesgaard F.
        • Lykkegaard-Nielsen M.
        • Justesen T.
        Intraincisional antibiotics in laparotomy wounds.
        Dis Colon Rectum. 1984; 27: 172-175
        • Nash A.G.
        • Hugh T.B.
        Topical ampicillin and wound infection in colon surgery.
        Br Med J. 1967; 1: 471-472
        • Andersen B.
        • Korner B.
        • Ostergaard A.H.
        Topical ampicillin against wound infection after colorectal surgery.
        Ann Surg. 1972; 72: 129-131
        • Mountain J.C.
        • Seal P.V.
        Topical ampicillin in grid-iron appendectomy wounds.
        Br J Clin Pract. 1970; 24: 111-115
        • Bates T.
        • Down R.H.L.
        • Houghton M.C.V.
        • Lloyd G.J.
        Topical ampicillin in the prevention of wound infection after appendectomy.
        Br J Surg. 1974; 61: 489-492
        • Andersen B.
        • Bendtsen A.
        • Holbraad L.
        • Schantz A.
        Wound infection after appendectomy.
        Acta Chir Scand. 1972; 138: 531-536
        • Juul P.
        • Merrild U.
        • Kronborg O.
        Topical ampicillin in addition to a systemic antibiotic prophylaxis in elective colorectal surgery.
        Dis Colon Rectum. 1985; 28: 804-806
        • Raahave D.
        • Pedersen T.
        • Kann D.
        No effect of topical ampicillin prophylaxis in elective operations of the colon or rectum.
        Surg Gynecol Obstet. 1989; 168: 112-114
        • Seco J.L.
        • Ojeda E.
        • Reguilon C.
        • et al.
        Combined topical and systemic antibiotic prophylaxis in acute appendicitis.
        Surgery. 1990; 159: 226-230
        • Al-Shehri M.A.
        • Saad S.
        • Ibrahim
        • et al.
        Topical ampicillin for prophylaxis against wound infection in acute appendicitis.
        Ann Saudi Med. 1994; 14: 233-236
        • Mackie B.
        • Shafi M.S.
        • Grundy D.J.
        • Ralphs D.N.
        • Haynes S.
        Topical ampicillin and Nothioxin antisepsis in appendectomy wounds.
        Br J Clin Pract. 1973; 27: 57-61
        • Hoogbergen J.A.
        Decreased incidence of appendectomy wound abscesses due to local application of ampiciliin.
        Arch Chir Neder. 1973; 25: 19-25
        • Jensen M.J.
        • McKenzie R.J.
        • Lake B.
        Topical ampicillin-cloxacillin in the prevention of abdominal wound sepsis.
        Br J Clin Pract. 1975; 29: 115-118
        • Parker M.C.
        • Mathams A.
        Systemic metronidazole combined with either topical povidone-iodine or ampicillin in acute appendicitis.
        J Hosp Infect. 1985; 6: 97-101
        • Tanphiphat C.
        • Sangsubhan C.
        • Vongvaravipatr V.
        • et al.
        Wound infection in emergency appendectomy: a prospective trial with tropical ampicillin and antiseptic solution irrigation.
        Br J Surg. 1978; 65: 89-91
        • Schultz A.
        • Jorgensen M.
        • Jorgensen P.
        Septic complications after appendectomy for perforated appendicitis.
        Acta Chir Scand. 1983; 149: 517-520
        • Ljungquist V.
        Wound sepsis after clean operations.
        Lancet. 1965; 1: 1095-1097
        • Walker C.
        • Van Voris L.P.
        Prophylactic antibiotics in acute non-perforated appendicitis.
        Ann Surg. 1982; 196: 735-736
        • Gorbach S.L.
        Antimicrobial prophylaxis for appendectomy and colorectal surgery.
        Rev Infect Dis. 1991; 13: S815-S820
        • Krukowski Z.H.
        • Irwin S.T.
        • Denholm S.
        • Matheson N.A.
        Preventing wound infection after appendectomy: a review.
        Br J Surg. 1988; 75: 1023-1033
        • Sterne J.A.
        • Egger M.
        • Smith G.D.
        Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis.
        BMJ. 2001; 323: 101-105
        • Mother D.
        • Cook D.J.
        • Eastwood S.
        • Olkin I.
        • Rennie D.
        • Stroup D.F.
        Improving the quality of reports of meta-analyses of randomized controlled trials. Quality of reporting of meta-analyses.
        Lancet. 1999; 354: 1896-1900

      Linked Article