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[Antibiotic treatment of perforated appendicitis in childhood--a prospective study]
Insights
For children with perforated appendicitis, combining mezlocillin and metronidazole significantly reduces post-operative complications and hospital stays. Early antibiotic therapy is crucial for better outcomes.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Clinical Pharmacology
Background:
- Perforated appendicitis in children is associated with significant post-operative complications.
- Current antibiotic regimens show variable effectiveness in preventing these complications.
Purpose of the Study:
- To evaluate the therapeutic effectiveness of different antibiotic regimens in reducing post-operative complications in children with perforated appendicitis.
- To compare the outcomes of various antibiotic treatments, including monotherapy and combination therapy.
Main Methods:
- Prospective randomized study involving 130 children with perforated appendicitis.
- Comparison of antibiotic regimens: Sulfometrol/Trimethoprim, mezlocillin alone, and mezlocillin with metronidazole.
- Retrospective analysis of 80 additional children treated with mezlocillin and metronidazole.
Main Results:
- The combination of mezlocillin and metronidazole demonstrated the lowest complication rate (10.8% in prospective, 10.2% in retrospective analysis).
- Sulfometrol/Trimethoprim was associated with a high complication rate (44.8%).
- Mean postoperative hospital stay decreased significantly with effective antibiotic regimens.
Conclusions:
- An effective antibiotic strategy for perforated appendicitis in children requires coverage against both aerobic and anaerobic microorganisms.
- Early initiation of appropriate antibiotic therapy is key to attenuating post-operative complications and reducing hospitalisation duration.
Abstract:
A prospective randomised study (I) was carried out on 130 children undergoing laparotomy for perforated appendicitis. The present study evaluates the therapeutic effectiveness of different antibiotic regimens in modifying the rate of post-operative complications (intraabdominal abscess, ileus, wound infiltration or abscess). During the first year of this study two treatment groups were used. Group A consisted of 29 children treated with Sulfometrol/Trimethoprim; the rate of postoperative complications was 44.8%. Group B consisted of 36 children treated with mezlocillin, the rate of complications being 13.8%. However, the same treatment with mezlocillin during the second year of the prospective study showed an increase of this rte to 39% (28 children--group C). The final group of 37 children was treated during the second year with mezlocillin and metronidazole (group D). The postoperative rate of complications was 10.8%. A retrospective analysis of further 80 children (study II) with perforated appendicitis treated with mezlocillin and metronidazole showed a consistent low rate of postoperative complications at 10.2%. In 6.8% of children studied, an operative intervention was necessary (four cases of ileus, four wound abscesses). The mean postoperative hospitalisation period decreased from 22.7 days in group A to 15.2 days in group D and finally to 14 days in study II. The present study shows that an effective and persistent attenuation of the rate of postoperative complications after perforated appendicitis in children depends on an early onset of therapy and on the appropriate choice of antibiotic drugs that are effective against aerobic and anaerobic microorganisms.