cefotaxime and Intestinal-Perforation

The efficacy of piperacillin/tazobactam at 100/12.5 mg/kg every 8 h (35 patients) was compared to cefotaxime plus metronidazole at 50/7.5 mg/kg every 8 h (35 patients) in 70 children with intra-abdominal infections requiring surgery. Diagnoses were gangrenous or perforated appendicitis (n =56), peritonitis (n =12), and abscess (n =2). Clinical cure was observed in 35 of 35 evaluable patients treated with piperacilin/tazobactam and in 34 of 34 evaluable patients treated with cefotaxime plus metronidazole. Presumed bacteriological eradication was noted in 29 of 30 evaluable patients in the piperacillin/tazobactam group and in 31 of 31 evaluable patients in the cefotaxime plus metronidazole group. In this study, piperacillin/tazobactam was as effective as cefotaxime plus metronidazole for treating children with intra-abdominal infections requiring surgery.

Topics: Abdominal Abscess; Adolescent; Appendicitis; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Intestinal Perforation; Male; Metronidazole; Microbial Sensitivity Tests; Penicillanic Acid; Peritonitis; Piperacillin; Prospective Studies; Tazobactam; Treatment Outcome

This prospective, randomized, double-blind study compares the efficacy, safety and cost-effectiveness of ampicillin, gentamicin and clindamycin (AGC) or cefotaxime and clindamycin (CC) for the treatment of children with complicated appendicitis. Ninety-seven children were randomized. Forty-seven were assigned to the AGC regimen and 50 received CC. Forty-two patients in the AGC group had an appropriate therapeutic outcome, whereas 48 of 50 children who received CC completed the trial successfully (p = NS). There were no differences between the groups with reference to the duration of antibiotic administration, fever, leukocytosis or length of hospitalization. Complications of therapy were uncommon and neither regimen demonstrated a significant advantage from an economic standpoint. We concluded that, in childhood, complicated appendicitis can be treated with either CC or AGC with equal efficacy.

Topics: Adolescent; Ampicillin; Appendicitis; Cefotaxime; Child; Child, Preschool; Clindamycin; Combined Modality Therapy; Cost-Benefit Analysis; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Gentamicins; Humans; Intestinal Perforation; Male; Premedication; Prospective Studies; Rupture, Spontaneous; Surgical Wound Infection