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Imipenem-cilastatin vs. tobramycin and metronidazole for appendicitis-related infections
M Uhari1, J Seppänen, E Heikkinen
1Department of Pediatrics, University of Oulu, Finland.
Insights
Imipenem-cilastatin demonstrated comparable efficacy and cost-effectiveness to tobramycin and metronidazole for treating pediatric appendicitis-associated abdominal infections. This antibiotic regimen is a viable option for children requiring appendectomy.
Area of Science:
- Pediatric Infectious Diseases
- Surgical Infections
- Antimicrobial Therapy
Background:
- Appendicitis-associated abdominal infections in children present a significant clinical challenge.
- Standard treatment often involves broad-spectrum antibiotics, but comparative efficacy data is crucial for optimal patient care.
- Understanding the impact of preoperative antibiotic choice on surgical site infections and recovery is essential.
Purpose of the Study:
- To compare the efficacy and safety of imipenem-cilastatin versus tobramycin and metronidazole for treating pediatric appendicitis-associated abdominal infections.
- To evaluate the impact of preoperative antibiotic administration on wound infection rates.
- To assess the rate of C-reactive protein reduction as an indicator of treatment response in perforated appendicitis.
Main Methods:
- An open, randomized trial involving 218 pediatric patients (2.5–16.8 years) undergoing appendectomy for suspected acute appendicitis.
- Patients were assigned to one of five treatment groups, comparing imipenem-cilastatin with tobramycin and metronidazole.
- Data collected included perforation rates, wound infection incidence, and C-reactive protein levels post-operatively.
Main Results:
- All patients showed a favorable response to treatment, regardless of the antibiotic regimen used.
- Preoperative imipenem administration showed a trend towards reduced wound infection rates (6.0%) compared to no preoperative antibiotics (12.0%), though not statistically significant (P=0.12).
- Patients with perforated appendicitis treated with imipenem-cilastatin exhibited a significantly faster decrease in C-reactive protein levels by the third postoperative day compared to those on tobramycin and metronidazole (58.2 mg/L vs. 89.4 mg/L, P < 0.05).
Conclusions:
- Imipenem-cilastatin is at least as effective as tobramycin and metronidazole for treating appendicitis-associated abdominal infections in children.
- The findings support imipenem-cilastatin as a valuable and economically comparable therapeutic option.
- Preoperative imipenem may contribute to lower surgical site infection rates in appendicitis cases.
Abstract:
The efficacy of imipenem-cilastatin was compared with that of tobramycin and metronidazole for the treatment of appendicitis-associated abdominal infections in children in an open, randomized trial. Two hundred eighteen patients between 2.5 and 16.8 years of age hospitalized for appendectomy because of suspected acute appendicitis were allocated to 5 treatment groups. The appendix was perforated in 54 (33.8%) of the 160 cases with appendicitis. All patients responded favorably to treatment. Infection in the wound occurred in 15 of 125 (12.0%) of those without preoperative antibiotic therapy and in 5 of 83 (6.0%) of those given imipenem preoperatively (P = 0.12; 95% confidence interval, -2.2 to 14.2%). C-reactive protein decreased significantly faster in those with perforated appendix treated with imipenem than in those treated with tobramycin and metronidazole (58.2 mg/liter vs. 89.4 mg/liter, P less than 0.05 on the third postoperative day). Imipenem-cilastatin was at least as effective and economically comparable as tobramycin and metronidazole for the treatment of appendicitis-associated infections in children.