Table 11: Anti-infectives versus placebo/no treatment

Table 11: Anti-infectives versus placebo/no treatment


Surgery type

n treatment/ control


Supplemental analgesia

Pain scores and type if specified

Use of supplemental analgesia

Other pain outcomes

Functional outcomes

Other important outcomes

(Balfour 2002) LoE 1

Closed haemorrhoidectomy with diathermy dissection


Oral metronidazole 400 mg (M) vs. placebo (P), three times daily for seven days after surgery

Cocodamol (codeine 30 mg plus paracetamol 500 mg) and diclofenac 50 mg as necessary

NS pain expected and pain experienced throughout 2 postop weeks (POD 1–7 and 14)


NS number of patients requiring rescue analgesia

Not reported

Time to first bowel movement:


Number of days to return to normal activity:


Overall satisfaction at 1 and 6 weeks:


(Carapeti 1998) LoE 1

Standard diathermy haemorrhoidectomy


Oral metronidazole 400 mg 3 x daily for 7 days (M) vs. placebo (P) at the same time points

Diclofenac 50 mg orally 3 x per day for 1 week, paracetamol or dihydrocodeine + paracetamol for additional analgesia

Pain scores experienced: M superior on day 5 (p=0.004), 6 (p=0.02) and 7 (p=0.006), NS on days 1–4

NS number of patients requiring paracetamol or codydramol for rescue analgesia

Summary scores experience of pain and pain expectation: M superior (p=0.004)

NS time to first bowel movement

Time to return to work/normal activities:

M superior (p=0.009)

Patient satisfaction scores:

M superior at 1 week (p=0.005), NS at 6 weeks

Incidence of complications:


(Al-Mulhim 2006)

LoE 1

Conventional diathermy dissection haemorrhoidectomy


IV metronidazole 500 mg at anaesthetic induction, at 2 h, and at 10 h postop, followed by 500 mg orally 3 x per day for 3 days (M), vs. no treatment (NT)

Diclofenac 50 mg orally 3 x per day. Pethidine injections 1mg/kg

Pain scores experienced: M superior on 0 (p?0.05), 1, 2, 3, 4, 5, 6 and 7 days (all p?0.001). Pain scores expected: M superior for 0–7 days (all p?0.001)

No stats on number of additional pethidine injections required – more patients in NT required them

Number of patients experiencing moderate pain (score 4-7): M superior (p=0.0233). Severe pain: M superior (no ‘p’ value reported). Expected pain: as expected M superior (p=0.0043), far worse M superior (no ‘p’ value reported).

Time to first bowel movement:


Complete wound healing at 6 weeks:

M superior (no stats)


M superior (no stats)

Time to return to normal activities: M superior (p?0.05)

Length of hospital stay:


Urinary retention:

M superior (no stats)

(Nicholson 2004) LoE 1

Closed three-quadrant Harmonic Scalpel® haemorrhoidectomy


Topical metronidazole 10% cream (M) vs. placebo cream (P); approximately 2.5 cc of cream applied to the surgical site three times daily for 28 days after a sitz bath or warm soak

Hydrocodone orally 10 mg every 4–6 h

VAS pain scores: M superior on day 7 (p=0.002) and 14 (p=0.02), NS on day 1, 2 and 28

NS narcotic requirement on days 1, 2, 7, 14 and 28

Not reported

Wound healing: postoperative oedema M superior (p<0.01), overall healing M superior (p=0.03)

Primary versus secondary healing:


Not reported