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Tobramycin-clindamycin versus cephalothin-cephalexin in the treatment of appendicular peritonitis
Insights
Appendicular peritonitis in children is a serious condition. Early diagnosis and antibiotic treatment, particularly with tobramycin-clindamycin, can reduce complications like wound infections.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Microbiology
Background:
- Appendicular peritonitis in children presents significant management challenges.
- Bacterial infections, including anaerobic organisms, are implicated in peritonitis complications.
Purpose of the Study:
- To compare the efficacy of tobramycin-clindamycin versus cephalothin/cephalexin in treating pediatric appendicular peritonitis.
- To investigate the role of bacterial species in infectious complications.
Main Methods:
- A randomized trial involving 47 children (ages 1-14) with appendicular peritonitis.
- Two treatment groups: tobramycin-clindamycin (n=27) and cephalothin followed by cephalexin (n=20).
- Analysis of complication rates, duration of symptoms, and microbial cultures from peritoneal fluid.
Main Results:
- Overall complication rate was 32%.
- Shorter symptom duration (<48 hours) correlated with significantly fewer complications.
- Tobramycin-clindamycin treatment resulted in significantly fewer wound infections.
- Aerobic and anaerobic bacteria were frequently isolated, often in polymicrobial infections.
Conclusions:
- Early diagnosis and prompt antibiotic administration are crucial for managing appendicular peritonitis.
- The combination of tobramycin-clindamycin appears effective in reducing wound infections, supporting the role of anaerobes.
- Antibiotics like clindamycin, metronidazole, or tinidazole should be considered in treatment regimens.
Abstract:
Forty-seven children, ages 1 to 14 years, with appendicular peritonitis were randomly divided into two groups: 27 were treated with the combination tobramycin-clindamycin and 20 with cephalothin followed by cephalexin. The overall rate of complications was 32%. Patients who had had their symptoms for less than 48 hours before being admitted to hospital had significantly fewer complications than those whose symptoms had lasted longer. Patients treated with tobramycin-clindamycin had significantly fewer wound infections. As clindamycin is effective against anaerobes this observation supports the view that anaerobes play an important role in the infectious complications in peritonitis. In this series, 12 species of aerobes and eight species of anaerobes were cultured from peritoneal fluid. In eight patients only one species was isolated; in the remaining 39 patients 29 different combinations of bacteria were encountered. Early diagnosis and administration of antibiotics preoperatively or during surgery, including clindamycin, metronidazol or tinidazol is recommended in the treatment of children with appendicular peritonitis.