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Comparative trial of four antibiotic combinations for perforated appendicitis in children
A O Ciftci1, F C Tanyel, N Büyükpamukçu
1Department of Pediatric Surgery, Hacettepe University Medical Faculty, Ankara, Turkey.
Insights
Four antibiotic regimens showed similar efficacy in treating perforated appendicitis in children. All treatments effectively covered common bacteria, with no significant differences in outcomes or complications observed across the groups.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Clinical Pharmacology
Background:
- Perforated appendicitis is a common surgical emergency in children.
- Optimal antibiotic therapy for perforated appendicitis remains a subject of investigation.
- Evaluating different antibiotic regimens is crucial for effective patient management.
Purpose of the Study:
- To compare the therapeutic efficacy of four distinct antibiotic regimens in pediatric patients undergoing surgery for perforated appendicitis.
- To assess the clinical and bacteriological outcomes of various antibiotic combinations versus single agents.
Main Methods:
- A prospective randomized study involving 200 pediatric patients (1-16 years) treated between 1991 and 1995.
- Patients were randomly assigned to one of four antibiotic treatment groups.
- Standard surgical procedures including appendicectomy and primary skin closure were performed, with Penrose drains for peritoneal drainage.
Main Results:
- No significant differences were found between the four antibiotic regimens in terms of clinical or bacteriological efficacy.
- All regimens effectively covered the predominant bacterial species, including Escherichia coli and Klebsiella spp.
- Complications such as wound infections and prolonged ileus occurred in 14 patients and were managed conservatively; no mortality was reported.
Conclusions:
- There is no definitive gold standard for antibiotic chemotherapy in pediatric perforated appendicitis.
- Multiple antibiotic combinations or single broad-spectrum agents providing aerobic and anaerobic coverage are safe and effective.
- Treatment decisions can be individualized based on available agents and local resistance patterns.
Objective:
To compare the therapeutic efficacy of four antibiotic regimens: penicillin, tobramycin, and clindamycin; penicillin, tobramycin, and ornidazole; piperacillin alone; and ceftriaxone and ornidazole in the treatment of children operated on for perforated appendicitis.
Design:
Prospective randomised study.
Setting:
Teaching hospital, Turkey.
Subjects:
200 patients aged between 1 and 16 years treated from December 1991 to December 1995 who were randomly assigned to one of four groups each consisting of 50 patients.
Interventions:
Preoperative antibiotics given intravenously, peritoneal drainage by Penrose drains without irrigation, appendicectomy with the inversion of the stump by a purse string, taking peritoneal swabs, and primary skin closure.
Main Outcome Measures:
Comparability of the groups, duration of fever, leucocytosis, antibiotic treatment, stay in hospital, nasogastric intubation, and drainage, as well as results of cultures and complications.
Results:
There were no significant differences between the groups for any variable studied. The predominant bacterial species were Escherichia coli, Klebsiella spp, Pseudomonas spp, Fusobacteria, and Peptostreptococci which were appropriately covered by all the antibiotic regimens. Fourteen patients had complications including wound infections (n = 10), prolonged ileus (n = 2) and intra-abdominal abscess (n = 2) all of which were treated conservatively. There was no mortality and no major complications. All regimens had the same clinical and bacteriological efficacy.
Conclusion:
There is no gold standard for antimicrobial chemotherapy in perforated appendicitis. Different antibiotic combinations or a single broad spectrum antibiotic, which include both aerobic and anaerobic coverage, can safely be used in children with perforated appendicitis.