Related Experiment Videos
A randomized trial of ticarcillin and clavulanate versus gentamicin and clindamycin in patients with complicated
1Department of Surgery, University of Texas Health Science Center, San Antonio 78284-7842.
Abstract:
Secondary bacterial peritonitis is usually a polymicrobial infection of facultative gram-negative aerobic and anaerobic organisms. Treatment consists of operation and broad-spectrum antibiotic administration. The antibiotic treatment of choice in these infections has been the combination of gentamicin and clindamycin. However, this combination can have toxic side effects and necessitates frequent monitoring of serum levels. Beta-lactam antibiotics provide broad-spectrum coverage and low toxicity, but can be inactivated by species of bacteria producing beta-lactamase enzymes. Clavulanic acid is a potent inhibitor of beta-lactamases and has been shown to extend the efficacy of ticarcillin to bacteria producing these enzymes. This combination was compared with gentamicin and clindamycin in 99 consecutive patients with complicated appendicitis. Eradication of identified pathogens was greater in the ticarcillin and clavulanate group (98 per cent) than in the gentamicin and clindamycin group (92 per cent), even for the subgroup of organisms producing beta-lactamases (97 versus 90 per cent eradication). Complications and clinical response were not significantly different between the two treatment groups. Ticarcillin and clavulanic acid is a safe and effective alternative to gentamicin and clindamycin in the treatment of secondary bacterial peritonitis and offers advantages in dosing simplicity and freedom from ototoxic and nephrotoxic effects.
Insights
Ticarcillin and clavulanic acid offers a safe and effective alternative for treating secondary bacterial peritonitis, showing superior pathogen eradication compared to gentamicin and clindamycin.
Area of Science:
- Infectious Diseases
- Pharmacology
- Surgical Infections
Background:
- Secondary bacterial peritonitis is a polymicrobial infection requiring broad-spectrum antibiotics.
- Gentamicin and clindamycin is the standard treatment but carries risks of toxicity and requires monitoring.
- Beta-lactam antibiotics are effective but can be inactivated by beta-lactamase-producing bacteria.
Purpose of the Study:
- To compare the efficacy and safety of ticarcillin and clavulanic acid versus gentamicin and clindamycin for treating secondary bacterial peritonitis.
- To evaluate pathogen eradication rates, particularly in beta-lactamase-producing organisms.
Main Methods:
- A comparative study involving 99 patients with complicated appendicitis.
- Patients were randomized to receive either ticarcillin and clavulanic acid or gentamicin and clindamycin.
- Pathogen eradication rates and clinical outcomes were assessed.
Main Results:
- Ticarcillin and clavulanic acid achieved higher pathogen eradication rates (98%) compared to gentamicin and clindamycin (92%).
- Eradication was also superior in beta-lactamase-producing organisms (97% vs. 90%).
- No significant differences in complications or clinical response were observed between the groups.
Conclusions:
- Ticarcillin and clavulanic acid is a safe and effective alternative to gentamicin and clindamycin for secondary bacterial peritonitis.
- This combination offers advantages in simpler dosing and avoids ototoxic and nephrotoxic effects.