Antibiotics in prevention of fistula following surgical treatment of simple anal abscess: A retrospective study

Abstract

Anorectal abscesses are commonly managed through prompt surgical drainage, yet progression to fistula-in-ano remains a significant postoperative complication.

Current guidelines discourage routine antibiotic use in simple anal abscesses, although emerging data challenge this practice.

This retrospective study evaluated the effectiveness of prophylactic ciprofloxacin and metronidazole in preventing fistula formation following surgical treatment of simple anal abscesses at Colonel Lotfi Hospital from January 2022 to December 2024.

Fifty-eight patients were included and stratified into two groups: those receiving postoperative antibiotics (n = 30) and those treated with drainage alone (n= 28).

Fistula formation occurred in 34.5 percent of cases overall, with a higher incidence observed in the antibiotic group versus the no-antibiotic group (40 percent vs. 28.6 percent, p = 0.39).

Antibiotic administration did not demonstrate a statistically significant protective effect.

Logistic regression identified symptom duration greater than two days and wound healing time exceeding twenty-one days as independent predictors of fistula development (p < 0.05).

These findings support existing recommendations against routine antibiotic prophylaxis in uncomplicated anal abscess drainage and highlight the importance of timely intervention and optimal wound healing.

Larger prospective studies are needed to better define high-risk patient subsets that may benefit from targeted antibiotic therapy.