brl-28500 and Appendicitis

The objective of this study was to compare ticarcillin/clavulanate given at 3.1 g every 6 hours with imipenem/cilistatin given at 500 mg every 6 hours for the treatment of infections associated with gangrenous or perforated appendicitis. One hundred thirty-seven patients were found to have gangrenous or perforated appendicitis and received the study medication for 3 to 5 days in a double-blinded, randomized manner. Clinical success was similar for the two treatment groups, 96.9 and 95.9 per cent in the ticarcillin/clavulanate and imipenem/cilistatin groups, respectively (P=0.99; 95% confidence interval for the difference was -5.6% to 7.6%). Bacteriologic success at the end of therapy was similar in the two groups, 100 and 98.4 per cent in the ticarcillin/clavulanate and imipenem/ cilistatin groups, respectively (P=0.99; 95% confidence interval for the difference was -1.8% to 4.7%). The occurrence of adverse events related to treatment was similar for the two groups (P=0.31) and led to study withdrawal for four patients (one with ticarcillin/clavulanate and three with imipenem/ cilistatin). Ticarcillin/clavulanate given at 3.1 g every 6 hours is as effective and as safe as imipenem/ cilistatin given at 500 mg every 6 hours for treatment of gangrenous or perforated appendicitis.

Topics: Adolescent; Adult; Aged; Appendicitis; Appendix; Child; Cilastatin; Cilastatin, Imipenem Drug Combination; Clavulanic Acids; Double-Blind Method; Drug Combinations; Drug Therapy, Combination; Female; Gangrene; Humans; Imipenem; Intestinal Perforation; Male; Middle Aged; Prospective Studies; Ticarcillin; Treatment Outcome

Standard therapy for childhood ruptured appendicitis includes combination antibiotic therapy with ampicillin, gentamicin and clindamycin. Complicated dosing schedules and the possibility of aminoglycoside toxicity make alternatives desirable. One such alternative is Timentin (a combination agent of ticarcillin disodium and clavulanate potassium). This agent has a more convenient dose schedule than standard therapy and eliminates the possibility of aminoglycoside ototoxicity and nephrotoxicity. It is active in vitro against most pathogens associated with ruptured appendicitis in children. The preliminary results of an ongoing prospective, open label, randomized trial comparing ticarcillin and clavulanate with ampicillin, gentamicin and clindamycin in childhood ruptured appendicitis are reported herein. While further evaluation is necessary, we have found single agent therapy with ticarcillin and clavulanate to be equivalent in safety and efficacy to standard combination therapy. Also discussed are the relative merits of immediate versus delayed primary closure of the abdominal wound after appendectomy.

Topics: Anti-Bacterial Agents; Appendectomy; Appendicitis; beta-Lactamase Inhibitors; Child; Child, Preschool; Clavulanic Acids; Combined Modality Therapy; Drug Evaluation; Drug Therapy, Combination; Humans; Intestinal Perforation; Premedication; Prospective Studies; Rupture, Spontaneous; Surgical Wound Infection; Ticarcillin

Antibiotic administration during acute appendicitis in children continues to be debated. The purpose of this study was to compare efficacy of two prophylactic antibiotic treatment guidelines in acute appendicitis and peritonitis in children.. The infectious complication rate after appendicectomy was compared during two distinct periods (before/after study). During the first period, the guidelines for antibiotic administration were based on ticarcillin-clavulanic acid. During the second period, the guidelines were based on amoxicillin-clavulanic acid for non-perforated appendicitis or appendicitis with localized peritonitis, and clavulanic acid was reserved for general peritonitis. All children younger than 16 years of age who underwent appendicectomy during the periods studied were included. Data were retrospectively collected from surgical and anesthetics charts.. Ninety-five children during the first period and 238 during the second were included. In the children with non-perforated appendicitis, no postoperative infectious complication occurred in 74 children during the first period versus two out of 153 (1%) during the second period. In cases of perforated appendicitis, postoperative infectious complications occurred two cases (10%) during the first period versus nine (11%) during the second. There were no significant differences between the two periods.. In this population, antibiotic administration guidelines based on amoxicillin-clavulanic acid for stages I-III of appendicitis maintained a low rate of postoperative infectious complications and were not associated with a higher postoperative infectious complication rate than guidelines based on ticarcillin-clavulanic acid.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Appendectomy; Appendicitis; Child; Child, Preschool; Clavulanic Acids; Female; Guideline Adherence; Humans; Male; Peritonitis; Retrospective Studies; Surgical Wound Infection; Ticarcillin

An increased incidence of post-surgical infectious complications in children admitted with a diagnosis of perforated appendicitis led to development of a disease-specific antibiogram and modification of our post-operative antibiotic regimen.. A historical control group comprised of 32 pediatric patients receiving ampicillin, gentamicin, and clindamycin (group AGC) was compared to a cohort of 32 children receiving ticarcillin/clavulanate plus gentamicin (group TG). The surgical procedure, peri-operative management, and inclusion, exclusion and discharge criteria were the same for each group. Outcome measures including length of stay, time to defervesce, incidence of infectious complications, and clinical failures to the antibiotic regimen were compared.. The groups were similar with respect to gender, age, weight, surgical time, pre-operative leukocytes, and number of intra-operative bacterial isolates cultured per patient. Length of stay was 10.1 days in group TG and 12.5 days for group AGC (p = 0.0197). The number of clinical failures was reduced from 9 (28.1%) to 2 (6.3%) in group TG (p = 0.02). The time to defervesce was decreased by 1.4 days, and the number of infectious complications was reduced to 2.5-fold in group TG patients.. Ticarcillin/clavulanate plus gentamicin was clinically more effective than ampicillin, gentamicin, and clindamycin combination therapy in the management of perforated appendicitis in our pediatric population.

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Appendicitis; Child; Child, Preschool; Clavulanic Acids; Clindamycin; Drug Therapy, Combination; Gentamicins; Humans; Infant; Intestinal Perforation; Penicillins; Retrospective Studies; Ticarcillin