amoxicillin-potassium-clavulanate-combination and Rectal-Diseases

The risk of fistula formation is a major concern after incision and drainage of an anorectal abscess.. Our objective was to the test the effects of antibiotic treatment on fistula formation after incision and drainage of anorectal abscesses.. Randomized, placebo-controlled, double-blind study.. Multicenter trial at 3 teaching hospitals in Turkey.. Patients who underwent abscess drainage between September 2005 and January 2008 were evaluated for eligibility. Exclusion criteria included penicillin allergy, antimicrobial agent usage before enrolment, other infection, previous anorectal surgery, inflammatory bowel disease, suspicion of Fournier gangrene, secondary and recurrent anorectal abscesses, anal fistula at time of the surgery, immune compromised states, and pregnancy.. Patients were randomly assigned to receive placebo or amoxicillin-clavulanic acid combination treatment for 10 days after abscess drainage.. The primary end point was rate of anorectal fistula formation at 1-year follow-up.. : Of 334 patients assessed for eligibility, 183 entered the study (placebo, 92; antibiotics, 91). Data were available for per-protocol analysis from 151 patients (placebo, 76; antibiotics, 75) with a mean age of 37.6 years; 118 patients (78.1%) were men. Overall, 45 patients (29.8%) developed anal fistulas during 1-year follow-up. Fistula formation occurred in 17 patients (22.4%) in the placebo group and in 28 patients (37.3%) in the antibiotic group (P = .044). Risk of fistula formation was increased in patients with ischiorectal abscess (odds ratio, 7.82) or intersphincteric abscess (odds ratio, 3.35) compared with perianal abscess.. Antibiotic treatment following the drainage of an anorectal abscess has no protective effect regarding risk of fistula formation.

Topics: Abscess; Adolescent; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anal Canal; Anti-Bacterial Agents; Anus Diseases; Chemotherapy, Adjuvant; Double-Blind Method; Drainage; Female; Humans; Intestinal Fistula; Logistic Models; Male; Middle Aged; Rectal Diseases; Young Adult

In a randomized trial of 440 patients undergoing elective colorectal surgery, the prophylactic efficacy and the safety of amoxycillin/clavulanic acid were compared with that of a control regimen of clindamycin and gentamicin. Surgical wound healing was assessed by the ASEPSIS points scale; it was normal in 86% of patients and the scores for both groups were not statistically different (amoxycillin/clavulanic acid: 11.1; clindamycin + gentamicin: 10.9). Intra-abdominal infections were more frequent in the clindamycin + gentamicin arm of the study (Fisher's exact test, P = 0.035). It is concluded that amoxycillin/clavulanic acid is as effective and safe as clindamycin + gentamicin in the prevention of wound infection and may provide better protection against intra-abdominal infections.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Clindamycin; Colonic Diseases; Cross Infection; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Rectal Diseases; Single-Blind Method; Wound Healing

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Anal Canal; Anti-Bacterial Agents; Anus Diseases; Humans; Intestinal Fistula; Rectal Diseases

This case is reported to inform physicians of a case of amoxicillin/clavulanate potassium use in a patient taking warfarin and the subsequent alteration (prolongation) in the international normalized ratio (INR) that resulted in the formation of a rectus sheath hematoma (RSH).. A 75-year-old man receiving long-term warfarin therapy developed a lower respiratory tract infection with paroxysmal coughing that was treated with oral amoxicillin 250 mg/clavulanate potassium 125 mg TID for 7 days. In the 3 days after completing antibiotic treatment, he developed increasingly severe lower abdominal pain that was clinically diagnosed as RSH. The patient was admitted to the local hospital for confirmation of the diagnosis and appropriate management. Before this episode, his INR was consistently within therapeutic range (2-3); on admission it had risen to 5.7. His condition was managed conservatively, and he was discharged home 6 days postadmission.. This case is reported to highlight the potential interaction between warfarin and amoxicillin/clavulanate potassium and subsequent RSH formation. The potential mechanism of the interaction between amoxicillin/clavulanate potassium and warfarin may be either pharmacokinetic (via metabolism in the cytochrome P4S0 system and preferential metabolism of clavulanate potassium in the liver) or pharmacodynamic (via interference with the production of vitamin K-dependent clotting factors II, VI, IX, and X).. This case of RSH in an elderly patient receiving long-term stable warfarin anticoagulation is probably associated with amoxicillin/clavulanate potassium use and paroxysmal coughing.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anticoagulants; Drug Interactions; Hematoma; Humans; International Normalized Ratio; Male; Rectal Diseases; Warfarin