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Antibiotic management of complicated appendicitis
Insights
Adding clindamycin to gentamicin and ampicillin significantly reduced treatment failures in children with complicated appendicitis. This combination therapy is recommended for improved outcomes in pediatric appendicitis cases.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Clinical Trials
Background:
- Complicated appendicitis in children poses significant treatment challenges.
- Antibiotic selection is crucial for managing pediatric appendicitis effectively.
Purpose of the Study:
- To compare the efficacy of gentamicin, ampicillin, and clindamycin (GAC) versus gentamicin, ampicillin, and placebo (GAP) in children with complicated appendicitis.
Main Methods:
- A prospective, randomized, double-blind clinical trial was conducted.
- 64 pediatric patients with complicated appendicitis were enrolled.
- Patients were randomized to receive either GAC or GAP.
Main Results:
- Therapeutic failure occurred in 3% of the GAC group versus 23% in the GAP group (P < 0.05).
- Duration of fever was significantly shorter in the GAC group (2.9 days) compared to the GAP group (4.7 days) (P < 0.05).
- Leukocytosis duration showed a trend towards shorter duration in the GAC group (3.2 days) versus GAP (4.9 days) (P = 0.08).
Conclusions:
- Gentamicin, ampicillin, and clindamycin (GAC) is a more effective treatment for complicated appendicitis in children than GAP.
- Routine use of GAC is recommended for improved clinical outcomes in pediatric complicated appendicitis.
Abstract:
A prospective, randomized, double-blind clinical trial was undertaken comparing gentamicin, ampicillin, and clindamycin (GAC) to gentamicin, ampicillin, and placebo (GAP) in children with complicated appendicitis. Of the 64 patients enrolled in this study, 33 were assigned to the GAC group and 31 received GAP. A single GAC patient (3%) was considered a therapeutic failure in comparison to seven children (23%) in the GAP group (P less than 0.05). Duration of fever was significantly prolonged in the GAP patients (4.7 +/- .8 days versus 2.9 +/- .5 days) when compared to the clindamycin treated children (P less than 0.05). Duration of leukocytosis was 3.2 +/- .4 days for GAC patients and 4.9 +/- .9 days for those on the GAP protocol (P = 0.08). On the basis of this experience the routine use of gentamicin, ampicillin, and clindamycin is recommended for all children with complicated appendicitis.