cefamandole and Appendicitis

Acute appendicitis continues as a medical challenge with newer approaches failing to improve diagnostic accuracy. The role of antibiotics in acute nonperforative appendicitis (NPA) remains unclear. In 175 patients studied at two hospitals, preoperative guidelines were used to exclude perforative appendicitis. Nevertheless, 14% of patients were found to have this condition. Surgeon's reports significantly underestimated the diagnosis when compared with the pathologists' reports. Antibiotic prophylaxis in 122 patients with NPA was studied prospectively comparing ceftizoxime (CTZ), cefamandole (CFM), and placebo (PLA). Ceftizoxime decreased the infection rate compared with PLA (0 vs. 8; P less than .01). Use of antibiotics (CTZ or CFM) resulted in decreased infections when compared with PLA (3 vs. 8; P less than .01) and fewer days of hospitalization (3.8 vs. 5.4 d, P less than .005). Analysis of infection risk factors showed no correlations except for failure to administer antibiotics and the finding of a gangrenous appendix. Operative culture results had no predictive value for either infection or pathogen identification. It is recommended that all patients undergoing surgery for NPA be given 1 d of antibiotic prophylaxis.

Topics: Acute Disease; Adolescent; Adult; Aged; Appendicitis; Ascitic Fluid; Bacterial Infections; Cefamandole; Ceftizoxime; Child; Clinical Trials as Topic; Diagnostic Errors; Double-Blind Method; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies; Random Allocation; Risk Factors

Costs associated with treating patients for gangrenous or perforated appendicitis were compared. Patients received single agent therapy with cefoperazone or cefamandole or combination antibiotics consisting of clindamycin and serum level-adjusted gentamicin. Forty-eight patients received cefamandole, 47 received cefoperazone, and 52 received combination clindamycin and gentamicin. Costs to the pharmacy for drugs were greater for the combination therapy; however, the higher failure rate associated with the cephalosporins created greater expenses for the single agent therapy than for combination therapy.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Appendicitis; Cefamandole; Cefoperazone; Clindamycin; Costs and Cost Analysis; Double-Blind Method; Drug Therapy, Combination; Gangrene; Gentamicins; Humans; Intestinal Perforation; Middle Aged; Retrospective Studies; Rupture, Spontaneous

A study of 130 adult patients with surgically treated gangrenous or perforated appendicitis was undertaken to evaluate the efficacy of three antibiotic regimens. Forty-eight patients received cefamandole, 40 were given the combination of clindamycin and gentamicin, and 42 were treated with cefoperazone. Side effects from these antibiotics were infrequent and mild. When all cases were compared for infectious failure, clindamycin-gentamicin showed a clear advantage over cefamandole. Because of the heterogeneity of the total study population, patients with perforation and peritonitis were compared separately. This analysis confirmed the advantage of clindamycin-gentamicin over cefamandole. In addition, it appears that clindamycin-gentamicin is more efficacious than cefoperazone.

Topics: Adolescent; Adult; Aged; Appendicitis; Cefamandole; Cefoperazone; Cephalosporins; Clindamycin; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Female; Gangrene; Gentamicins; Humans; Intestinal Perforation; Male; Middle Aged; Peritonitis; Random Allocation

The authors question the need to give prophylactic antibiotics perioperatively in all cases of acute appendicitis without perforation to reduce the rate of wound infection. A retrospective study of 82 patients showed a wound infection rate of 4.8%; 3 of 53 patients who did not receive antibiotics had a wound infection compared with 1 of 29 patients who received antibiotics. A prospective double-blind clinical trial was performed comparing the results of perioperative administration of cefamandole and placebo. One of 21 patients who received the placebo had a wound infection; none of the 21 patients given cefamandole had infection. Thus, the authors conclude that, although reports in the literature suggest that antibiotics given perioperatively decrease the rate of wound infection in acute appendicitis without perforation, the incidence of such infection is too low to warrant routine administration. They suggest that such antibiotic use be reserved for those suspected of having more serious disease.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Appendectomy; Appendicitis; Cefamandole; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Humans; Premedication; Retrospective Studies; Surgical Wound Infection

A prospective, randomized, double-blind clinical study was performed to determined the efficacy of short-term (24 hr) perioperative antibiotics in preventing septic complications after emergency appendectomy for nonperforated appendicitis. The patients were stratified into three clinical arms: Group I (placebo, n = 45), Group II (cefamandole, n = 46) and Group III (cefamandole plus carbenicillin, n = 45). The three groups of patients were similar in regard to age, sex, duration of operation and pathologic classification of the appendix. The overall incidence of infection in the study was 5.1%. The infection rates in Groups II (2.2%) and III (0%) were significantly lower than Group I (placebo) (13.3%), (p less than 0.05). No difference was observed between cefamandole alone and cefamandole plus carbenicillin. Average postoperative hospital days per patient for each group was: Group I - 3.8 days; Group II - 2.9 days; Group III - 3.1 days. Cost analysis of hospitalization including cost of prophylactic antibiotics revealed a $247.99 per patient saving for Group II versus Group I and $95.53 for Group III versus Group I. Systemic prophylactic antibiotics can successfully reduce septic complications after appendectomy for nonperforated appendicitis, and a single drug (cefamandole) directed at the facultative pathogens is as effective as double drug therapy, which includes specific anaerobic coverage.

Topics: Acute Disease; Adolescent; Adult; Aged; Appendicitis; Bacterial Infections; Carbenicillin; Cefamandole; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Rupture, Spontaneous

Antibiotics can be associated with hypoprothrombinaemic haemorrhages in risk patients. Risk factors are: poor nutrition, impaired liver- or renal function, coagulation depleting medical therapy or illness. Pathogenetically there is a vitamin K deficiency with reduction of vitamin K dependent clotting factors; mainly by decreased vitamin K synthesis in intestinal bacterias. In consequence every risk patient under antibiotics should receive vitamin K prophylactically and in a parenteral way, because of unreliable resorption in gastrointestinal tract. Prothrombin-time-monitoring is essential to recognize the hypoprothrombinemia in every risk patient under antibiotics.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Appendicitis; Cefamandole; Diverticulitis, Colonic; Female; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Hypoprothrombinemias; Intestinal Perforation; Male; Ornidazole; Postoperative Complications; Premedication

The relationships between resistant pathogens, serum levels of gentamicin, and the outcomes of gangrenous or perforated appendicitis were analyzed in 147 patients. Failure to cure the infection occurred significantly more frequently among patients treated with cefoperazone or cefamandole than among those treated with clindamycin and gentamicin in combination. The failures were associated with recovery of resistant Bacteroides fragilis from intraoperative cultures. Pseudomonas species were also associated with failures, their in vitro susceptibility not correlating with clinical cure. Patients with gentamicin peak serum levels of less than 6 micrograms/ml in the first three days were not more likely to be associated with failure than were patients with higher levels. These clinical observations indicate that antibiotic therapy of intra-abdominal sepsis should include antibiotics with in vitro activity against B fragilis and that precise adjustments of gentamicin levels may not improve outcome. In addition, Pseudomonas species may play a significant role in some of these infections.

Topics: Anti-Bacterial Agents; Appendicitis; Bacteroides fragilis; Bacteroides Infections; Cefamandole; Cefoperazone; Cephalosporins; Clindamycin; Drug Therapy, Combination; Female; Gangrene; Gentamicins; Humans; Male; Pseudomonas; Pseudomonas Infections; Rupture, Spontaneous