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Meropenem versus tobramycin with clindamycin in the antibiotic management of patients with advanced appendicitis
T V Berne1, A E Yellin, M D Appleman
1Department of Surgery, School of Pharmacy, University of Southern California, Los Angeles, USA.
Background:
Meropenem (MP), a new carbapenem antibiotic, has excellent antimicrobial activity against the enteric flora commonly encountered in acute appendicitis. Although similar to imipenem, it may have clinical advantages.
Study Design:
We compared patients with advanced appendicitis (gangrenous or perforated) treated with 1,000 mg MP every eight hours with those given the combination of tobramycin 5 mg/kg/day at eight hour intervals and clindamycin 900 mg every eight hours. Both treatments were given intravenously. Patients were randomized to either group of the double-blind study.
Results:
Of 129 evaluable cases, 63 received MP and 66 received both tobramycin and clindamycin (T/C). The two groups were similar in age, sex, and severity of disease. The mean number of days of postoperative fever (MP = 3.1 +/- 1.7 SD compared to T/C = 4.4 +/- 2.2 SD, p < or = 0.01), days of antibiotic therapy (MP = 6.1 +/- 1.6 SD compared to T/C = 7.3 +/- 2.2 SD, p = 0.01), and therefore hospital stay (MP = 8.0 +/- 3.5 SD compared to T/C = 9.4 +/- 2.6 SD, p < 0.01) were significantly better for patients treated with MP. No difference was found between the numbers of failures in each group (MP = 5 compared to T/C = 6).
Conclusions:
This study demonstrates a small but significant reduction (approximately one day) in post-operative fever, duration of antibiotic treatment, and hospital stay for patients treated with MP compared to those treated with T/C.
Insights
Meropenem (MP) offers a significant reduction in post-operative fever, antibiotic duration, and hospital stay for acute appendicitis patients. This new carbapenem antibiotic shows clinical advantages over traditional treatments.
Area of Science:
- Infectious Diseases
- Pharmacology
- Surgical Infections
Background:
- Meropenem (MP) is a carbapenem antibiotic with broad-spectrum activity against enteric flora.
- MP demonstrates potential clinical advantages over imipenem for treating appendicitis.
Purpose of the Study:
- To compare the efficacy of meropenem (MP) versus tobramycin/clindamycin (T/C) in patients with advanced appendicitis.
- To evaluate clinical outcomes including fever duration, antibiotic treatment length, and hospital stay.
Main Methods:
- A double-blind, randomized study comparing intravenous MP (1000 mg q8h) with intravenous tobramycin/clindamycin (T/C) in advanced appendicitis.
- 129 patients with gangrenous or perforated appendicitis were randomized into two treatment groups.
Main Results:
- Patients receiving MP experienced significantly shorter durations of post-operative fever (3.1 vs. 4.4 days, p < 0.01).
- MP treatment resulted in shorter antibiotic therapy (6.1 vs. 7.3 days, p = 0.01) and hospital stays (8.0 vs. 9.4 days, p < 0.01).
- No significant difference in treatment failure rates was observed between the MP and T/C groups.
Conclusions:
- Meropenem (MP) provides a statistically significant, albeit modest, reduction in key clinical indicators for advanced appendicitis.
- MP demonstrates clinical utility by shortening recovery times compared to the combination of tobramycin and clindamycin.