cefamandole and Gangrene

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 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