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One-drug versus two-drug antibiotic therapy in pediatric perforated appendicitis: a prospective randomized study
J L Meller1, H M Reyes, D S Loeff
1Division of Pediatric Surgery, University of Illinois College of Medicine, Chicago and Cook County Hospital 60612.
Insights
Cefoxitin and the combination of gentamicin and clindamycin showed no significant differences in treating perforated appendicitis in children. Both antibiotic regimens resulted in similar infection rates and hospital stays, indicating comparable efficacy.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Pharmacology
Background:
- Perforated appendicitis in children presents a significant surgical challenge.
- Effective antibiotic management is crucial for reducing complications.
Purpose of the Study:
- To compare the efficacy of cefoxitin versus gentamicin and clindamycin for perforated appendicitis in pediatric patients.
- To evaluate disease-related and drug-related complications between the two antibiotic regimens.
Main Methods:
- Prospective randomized study involving 56 pediatric patients with perforated appendicitis (1986-1989).
- Patients were randomized to receive either cefoxitin (n=29) or gentamicin and clindamycin (n=27).
- Antibiotics administered pre- and post-operatively for at least 6 days; surgical wounds managed with secondary closure.
Main Results:
- No significant difference in infection complications or length of hospital stay between the cefoxitin and gentamicin/clindamycin groups.
- Common pathogens included Escherichia coli (62%) and Bacteroides species (46%).
- No antibiotic changes were required due to susceptibility, and no adverse drug reactions were reported.
Conclusions:
- Cefoxitin is as effective as the combination of gentamicin and clindamycin in treating perforated appendicitis in pediatric patients.
- Both treatment strategies demonstrate comparable safety and clinical outcomes.
- The choice between cefoxitin and gentamicin/clindamycin can be based on factors beyond efficacy for this condition.
Abstract:
A prospective randomized study was undertaken to compare the use of the combination of gentamicin and clindamycin with single agent, cefoxitin, in the treatment of perforated appendicitis in the pediatric patient. In a 3-year period from 1986 to 1989, 56 patients with perforated appendicitis were randomized. Twenty-nine patients received cefoxitin, and 27 patients received gentamicin and clindamycin. Antibiotics were started before operation and continued for a minimum of 6 days after operation. Skin and subcutaneous tissues were left open at surgery and closed secondarily after day 3, if they appeared to be clean. Wounds were considered infected if they developed increased purulence with positive wound cultures. Age range was similar in both groups, with a mean of 9 years (range, 1 to 17 years); 28 were boys and 28 were girls. No changes in antibiotics were required for reasons of susceptibility. No adverse drug reactions occurred in either group. The most common organisms were Escherichia coli in 35 cases (62%) and Bacteroides species in 26 cases (46%). No difference was noted in infection complications in the two groups nor in length of hospital stay. Therefore, no difference is evident in the use of cefoxitin versus gentamicin and clindamycin in the treatment of perforated appendicitis in terms of disease or drug-related complications.