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Related Experiment Videos

Adjunctive antimicrobial therapy for complicated appendicitis: bacterial overkill by combination therapy

J A Hopkins1, S E Wilson, D G Bobey

  • 1Department of Surgery, University of California, Irvine Medical Center, Orange 92668.

World Journal of Surgery
|November 1, 1994
PubMed
Summary

Single-agent cefotetan monotherapy demonstrated comparable efficacy to combination therapy for complicated appendicitis, offering an economical and effective treatment option. This approach simplifies antibiotic regimens, potentially reducing costs and complications in surgical patients.

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Area of Science:

  • Infectious Diseases
  • Surgical Infections
  • Pharmacology

Background:

  • General surgeons often use multiple antimicrobial agents for appendicitis, despite the availability of broad-spectrum single agents.
  • The clinical benefit of using multiple antimicrobials over single agents for complicated appendicitis remains unclear.

Purpose of the Study:

  • To compare the clinical efficacy of cefotetan monotherapy versus combination therapy (clindamycin/amikacin) in patients with complicated appendicitis.
  • To evaluate the in vitro susceptibility advantage of multiple antimicrobials as adjunctive therapy.

Main Methods:

  • Prospective, double-blind, randomized trial involving 114 patients undergoing surgery for complicated appendicitis.
  • Patients were assigned to receive either cefotetan or clindamycin/amikacin.

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  • Outcomes assessed included clinical resolution of intra-abdominal infections and postoperative infectious complications.

    • Main Results:

    • Clinical resolution rates were high and similar between groups: 90% for cefotetan and 86% for clindamycin/amikacin (p = 0.11).
    • Fewer patients required antibiotic therapy changes due to complications in the cefotetan group (2.8%) compared to the clindamycin/amikacin group (12.5%) (p = 0.07).
    • Adverse drug events were comparable, primarily transient liver function test elevations.

    Conclusions:

    • Monotherapy with cefotetan is an economical and effective adjunctive regimen for complicated appendicitis.
    • Single-agent broad-spectrum cephalosporins simplify treatment and are suitable for most cases.
    • Potent antimicrobials should be reserved for resistant organisms or nosocomial infections.