cefoxitin and Appendicitis

Acute appendicitis is the most common acute surgical disease in childhood and it still presents frequent septic complications. This prospective and randomized study compares the efficacy of two cephalosporins (cefoxitin and ceftizoxime) in terms of clinical response, in vitro activity and characteristics of use in clinical practice.. Of the 288 children with acute appendicitis admitted over a period of 15 months, 148 received cefoxitin (100 mg/kg/24 h; Group I) and 140 ceftizoxime (100 mg/kg/24 h; Group II) RESULTS: No significant differences were seen between these two groups in clinical response or infectious complication rates. In addition, activities of both antimicrobial agents against pathogens recovered from the peritoneal cultures of all patients were similar. The overall most common isolates were E. coli (75.5%), bacteroides species (33.7%) and Pseudomonas (32.4%).. We conclude that ceftizoxime is as effective as cefoxitin and can be surely employed in the treatment of acute appendicitis in children. Its addition, its longer half-life simplifies its use in clinical practice.

Topics: Acute Disease; Adolescent; Appendicitis; Bacterial Infections; Cefoxitin; Ceftizoxime; Cephalosporins; Cephamycins; Child; Child, Preschool; Female; Humans; Infant; Male; Postoperative Complications; Prospective Studies

A prospective, double-blind study was performed to examine the effects of prophylactic cefotetan and cefoxitin in postoperative wound infection for patients with nonperforated acute appendicitis.. One hundred thirty-six of 179 patients with a clinical diagnosis of appendicitis were evaluated and divided into three groups: group 1 received 2 g cefotetan preoperatively, group 2 received 2 g cefoxitin preoperatively, and group 3 received 2 g cefoxitin preoperatively followed by three postoperative doses.. The overall wound infection rate was 4.6 percent. Group 2 (single-dose cefoxitin) had a significantly higher wound infection rate (11.1 percent) than group 1 (single-dose cefotetan) (zero percent) or group 3 (multiple-dose cefoxitin) (1.9 percent).. Single-dose cefotetan and multiple-dose cefoxitin are equally effective. However, because of the greater convenience and markedly decreased cost, single-dose cefotetan is the prophylaxis of choice in appendectomy for nonperforated appendicitis.

Topics: Acute Disease; Adult; Appendectomy; Appendicitis; Cefotetan; Cefoxitin; Double-Blind Method; Female; Humans; Male; Premedication; Prospective Studies; Surgical Wound Infection

A randomized prospective study of antibiotic prophylaxis using a single dose of either cefoxitin or piperacillin is presented. The trial was carried out in Al Ain Hospital in the period 1989-1992 on 250 adult patients with non-perforated appendicitis. One group (124 patients) received 2 g cefoxitin, the other group (126 patients) 2 g piperacillin. Antibiotics were administered intravenously in the operating theatre immediately before surgery. Wound infection occurred in three patients, 2.4% of the cefoxitin group and in five patients (4%) of the second group (with no significant difference). The commonest infecting organisms were Escherichia coli (5 out of 8). Mean hospital stay for patients with wound infection was 15 days (range 12-21) compared with 6 days, (range 4-8) for non-infected cases. Prophylactic cefoxitin or piperacillin were each therefore similarly effective in minimizing the rate of wound infections in patients with non-perforated appendicitis.

Topics: Acute Disease; Adolescent; Adult; Appendectomy; Appendicitis; Cefoxitin; Combined Modality Therapy; Female; Humans; Infusions, Intravenous; Length of Stay; Male; Middle Aged; Piperacillin; Premedication; Prospective Studies; Surgical Wound Infection

A prospective randomized study was undertaken to compare the use of the combination of gentamicin and clindamycin with single agent, cefoxitin, in the treatment of perforated appendicitis in the pediatric patient. In a 3-year period from 1986 to 1989, 56 patients with perforated appendicitis were randomized. Twenty-nine patients received cefoxitin, and 27 patients received gentamicin and clindamycin. Antibiotics were started before operation and continued for a minimum of 6 days after operation. Skin and subcutaneous tissues were left open at surgery and closed secondarily after day 3, if they appeared to be clean. Wounds were considered infected if they developed increased purulence with positive wound cultures. Age range was similar in both groups, with a mean of 9 years (range, 1 to 17 years); 28 were boys and 28 were girls. No changes in antibiotics were required for reasons of susceptibility. No adverse drug reactions occurred in either group. The most common organisms were Escherichia coli in 35 cases (62%) and Bacteroides species in 26 cases (46%). No difference was noted in infection complications in the two groups nor in length of hospital stay. Therefore, no difference is evident in the use of cefoxitin versus gentamicin and clindamycin in the treatment of perforated appendicitis in terms of disease or drug-related complications.

Topics: Adolescent; Appendicitis; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Clindamycin; Drug Therapy, Combination; Female; Gentamicins; Humans; Intestinal Perforation; Male; Prospective Studies

A comparison of single-agent antimicrobial therapy in the treatment of patients with perforated or gangrenous appendicitis and peritonitis was performed in a double-blind, randomized, prospective trial. Pathologic documentation of advanced appendicitis and positive intraoperative specimen cultures were required for inclusion in the study. Ceftizoxime (2 gm every 12 hours) and cefoxitin (2 gm every six hours) were compared. There were no significant differences between the treatment groups. Ninety-seven percent of patients treated with ceftizoxime and 89% of those treated with cefoxitin were cured or improved; there was no mortality in either group. By the use of optimal sampling, transport, and culture techniques, the number and diversity of bacteria recovered from these patients with advanced appendicitis were found to be much larger than previously suspected. Peritoneal fluid, abscess contents (if present), and appendiceal tissue (obtained so as to exclude the lumen) were cultured from all patients. An average number of 3.1 aerobic or facultative bacteria species and 8.5 anaerobic species were isolated from each specimen. Twenty-eight different genera and more than 55 species were encountered, including a previously undescribed fastidious gram-negative anaerobic bacillus. Bacteroides fragilis group and Escherichia coli were isolated from almost all specimens, and within the B fragilis group, eight species were represented. The recovery of such an unexpectedly large and diverse flora may be the reason for the therapeutic failures in these patients. We conclude that single-agent antimicrobial therapy in patients with advanced appendicitis and peritonitis is both safe and effective, and, with ceftizoxime, can be accomplished by a twice-daily dosing regimen.

Topics: Adult; Appendicitis; Bacteria, Aerobic; Bacteria, Anaerobic; Cefoxitin; Ceftizoxime; Double-Blind Method; Female; Gangrene; Humans; Intestinal Perforation; Male; Peritonitis; Randomized Controlled Trials as Topic; Rupture, Spontaneous

In a prospective, block-randomized, multicenter study, the safety and efficacy of cefoxitin in preoperative prophylaxis were studied. 1735 patients undergoing appendectomy were evaluable, and half of these patients received 2 g of cefoxitin before undergoing operation. The patients were divided into three groups: patients with a normal appendix, patients with an acutely inflamed appendix, and patients with a gangrenous appendix. The study showed for each group a significant reduction of the incidence of wound infection in patients receiving prophylaxis. However, intra-abdominal abscess formation was not influenced by preoperative antibiotic prophylaxis. Consequently, routine preoperative prophylaxis is recommended before appendectomy.

Topics: Abdomen; Abscess; Acute Disease; Adult; Appendectomy; Appendicitis; Cefoxitin; Denmark; Female; Humans; Male; Multicenter Studies as Topic; Premedication; Prospective Studies; Random Allocation; Surgical Wound Infection

Two hundred and forty adults undergoing acute appendicectomy were randomised to receive either cefoxitin or ceftriaxone 1 g intravenously at induction of anaesthesia. Patients were monitored daily while in hospital, and at least 4 weeks after discharge for evidence of wound, urinary or lower respiratory tract infection. We evaluated 167 patients at follow up and found no significant difference in infection rates between the two antibiotic groups. Thirty-four had normal appendices and 1 of 16 (6.3%) given cefoxitin and 2 of 18 (11.1%) given ceftriaxone developed wound infections. Ninety-seven had acute appendicitis and 3 of 48 (6.3%) given cefoxitin and 3 of 49 (6.1%) given ceftriaxone developed infections including 2 wound infections in each group. Thirty-six had gangrenous perforated or abscessed appendices: 31 were given additional antibiotics postoperatively, and 4 of 18 (22.2%) in each prophylactic antibiotic group developed infections, including wound infection in 3 given cefoxitin and in 4 given ceftriaxone. None of the infections were serious. Sixty-one percent presented after discharge from hospital. The mean hospital stay was 4.6 days for each antibiotic group. Neither antibiotic caused adverse effects.

Topics: Abscess; Adolescent; Adult; Appendectomy; Appendicitis; Cefoxitin; Ceftriaxone; Humans; Intestinal Perforation; Middle Aged; Premedication; Random Allocation; Rupture, Spontaneous; Surgical Wound Infection

Three hundred and seven patients with appendicitis were randomized to receive cefoxitin or gentamicin and metronidazole. For early appendicitis, a single preoperative dose of antibiotics was given. For late cases, the antibiotics were continued postoperatively for seven days. Both cefoxitin and gentamicin-metronidazole were effective in the reduction of post-appendicectomy septic complications in early or late appendicitis and there was no statistically significant difference between them. Mild transient and reversible nephrotoxicity was detected in 1.9% of patients who received gentamicin-metronidazole for seven days. Nephrotoxicity was not detected in any other patients. The cost of cefoxitin is higher, but this has to be balanced against the costs of monitoring serum gentamicin and creatinine levels, and the need to adjust the gentamicin dosage in 19% of patients when gentamicin-metronidazole was used. Both cefoxitin and gentamicin-metronidazole are effective and safe when used carefully. Cefoxitin has a slight advantage in its lack of potential nephrotoxicity and ototoxicity.

Topics: Adolescent; Adult; Appendectomy; Appendicitis; Bacterial Infections; Cefoxitin; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Metronidazole; Middle Aged; Premedication; Prospective Studies; Random Allocation

A prospective controlled randomized-block multicenter study was carried out in 209 patients undergoing surgery for perforated or ruptured appendicitis. The patients received either cefoxitin or ampicillin + metronidazole for 5 days. The treatment was started peroperatively. In both groups wound infections were found to be less than 10 per cent and no difference could be demonstrated. However cefoxitin was significantly superior to ampicillin + metronidazole in preventing intra-abdominal abscesses (P less than 0.05). Cefoxitin offers a single drug treatment that adequately reduces postoperative infectious complications in patients undergoing surgery for perforated or ruptured appendicitis.

Topics: Abdomen; Abscess; Adolescent; Adult; Aged; Ampicillin; Appendectomy; Appendicitis; Cefoxitin; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Male; Metronidazole; Middle Aged; Prospective Studies; Rupture, Spontaneous; Surgical Wound Infection

A prospective, randomized, double-blind clinical study was performed to determine the efficacy of perioperative systemic antibiotics in preventing infection after appendectomy for acute nonperforating appendicitis. One hundred three patients received three doses of either placebo (saline, n = 52) or cefoxitin sodium (n = 51). The two groups were similar with regard to age distribution, sex ratio, duration of operation, pathologic condition of appendix, and hospital stay. Postoperative wound infections were detected in 9.6% of the placebo-treated patients, whereas none occurred in the cefoxitin group. All but one infection appeared after discharge. Cost analysis identified a net savings of $ 84 per patient with the use of prophylactic antibiotics. Septic morbidity after appendectomy for nonperforating appendicitis is significantly reduced by systemic antibiotics, and brief administration of a single broad-spectrum agent (cefoxitin) is effective prophylaxis.

Topics: Adolescent; Adult; Aged; Appendicitis; Cefoxitin; Child; Child, Preschool; Cost-Benefit Analysis; Double-Blind Method; Female; Humans; Intraoperative Care; Male; Middle Aged; Postoperative Complications; Prospective Studies; Random Allocation; Wound Infection

In severe appendicitis, the effect of a single intravenous dose of metronidazole (500 mg) was compared with cefoxitin (1 g). The antibiotics were given by random allocation once the diagnosis had been established at operation. In the metronidazole group, 5 out of 48 patients developed a wound infection whilst in hospital compared with 13 out of 48 in the cefoxitin group (P = 0.036). However, 57% of wound infections became apparent after the patient went home and the overall infection rates were similar. The mean length of postoperative hospital stay was 5.0 days in the metronidazole group and 6.8 days in the cefoxitin group (P = 0.052), but of those who did develop a wound infection, the length of stay was almost double in the cefoxitin group. Anaerobic organisms were cultured from the wound in 7 out of 15 patients who received cefoxitin but in none of 5 patients in the metronidazole group. Whilst metronidazole only delayed the discharge of pus from the wound, it did seem to reduce the severity of infection. Cefoxitin appeared to be less effective, given as a single intravenous injection at a dose of 1 g.

Topics: Adult; Appendicitis; Cefoxitin; Child; Child, Preschool; Female; Humans; Intraoperative Period; Length of Stay; Male; Metronidazole; Surgical Wound Infection

To evaluate whether redosing antibiotics within an hour of incision is associated with a reduction in incisional surgical site infection (iSSI) in children with appendicitis.. Existing data remain conflicting as to whether children with appendicitis receiving antibiotics at diagnosis benefit from antibiotic redosing before incision.. This was a multicenter retrospective cohort study using data from the Pediatric National Surgical Quality Improvement Program augmented with antibiotic utilization and operative report data obtained though supplemental chart review. Children undergoing appendectomy at 14 hospitals participating in the Eastern Pediatric Surgery Network from July 2016 to June 2020 who received antibiotics upon diagnosis of appendicitis between 1 and 6 hours before incision were included. Multivariable logistic regression was used to compare odds of iSSI in those who were and were not redosed with antibiotics within 1 hour of incision, adjusting for patient demographics, disease severity, antibiotic agents, and hospital-level clustering of events.. A total of 3533 children from 14 hospitals were included. Overall, 46.5% were redosed (hospital range: 1.8%-94.4%, P <0.001) and iSSI rates were similar between groups [redosed: 1.2% vs non-redosed: 1.3%; odds ratio (OR) 0.84, (95%,CI, 0.39-1.83)]. In subgroup analyses, redosing was associated with lower iSSI rates when cefoxitin was used as the initial antibiotic (redosed: 1.0% vs nonredosed: 2.5%; OR: 0.38, (95% CI, 0.17-0.84)], but no benefit was found with other antibiotic regimens, longer periods between initial antibiotic administration and incision, or with increased disease severity.. Redosing of antibiotics within 1 hour of incision in children who received their initial dose within 6 hours of incision was not associated with reduction in risk of incisional site infection unless cefoxitin was used as the initial antibiotic.

Topics: Anti-Bacterial Agents; Appendectomy; Appendicitis; Cefoxitin; Child; Humans; Retrospective Studies; Surgical Wound Infection; Treatment Outcome

To compare rates of surgical site infection between the 2 most commonly utilized narrow-spectrum antibiotic regimens in children with uncomplicated appendicitis (ceftriaxone with metronidazole and cefoxitin alone).. Narrow-spectrum antibiotics have been found to be equivalent to extended-spectrum (antipseudomonal) agents in preventing surgical site infection (SSI) in children with uncomplicated appendicitis. The comparative effectiveness of different narrow-spectrum agents has not been reported.. This was a multicenter retrospective cohort study using clinical data from the Pediatric National Surgical Quality Improvement Program Appendectomy Collaborative Pilot database merged with antibiotic utilization data from the Pediatric Health Information System database from January 2013 to June 2015. Multivariable logistic regression was used to compare outcomes between antibiotic treatment groups after adjusting for patient characteristics, surrogate measures of disease severity, and clustering of outcomes within hospitals.. Eight hundred forty-six patients from 14 hospitals were included in the final study cohort with an overall SSI rate of 1.3%. A total of 56.0% of patients received ceftriaxone with metronidazole (hospital range: 0%-100%) and 44.0% received cefoxitin (range: 0%-100%). In the multivariable model, ceftriaxone with metronidazole was associated with a 90% reduction in the odds of a SSI compared to cefoxitin [0.2% vs 2.7%; odds ratio: 0.10 (95% confidence interval 0.02-0.60); P = 0.01].. Ceftriaxone combined with metronidazole is superior to cefoxitin alone in preventing SSIs in children with uncomplicated appendicitis.

Topics: Anti-Bacterial Agents; Appendectomy; Appendicitis; Cefoxitin; Ceftriaxone; Child; Drug Therapy, Combination; Female; Humans; Male; Metronidazole; Retrospective Studies; Surgical Wound Infection

The aim of this study was to compare the effectiveness of extended versus narrow spectrum antibiotics in preventing surgical site infections (SSIs) and hospital revisits in children with uncomplicated appendicitis.. There is a paucity of high-quality evidence in the pediatric literature comparing the effectiveness of extended versus narrow-spectrum antibiotics in the prevention of SSIs associated with uncomplicated appendicitis.. Clinical data from the ACS NSQIP-Pediatric Appendectomy Pilot Project were merged with antibiotic utilization data from the Pediatric Health Information System database for patients undergoing appendectomy for uncomplicated appendicitis at 17 hospitals from January 1, 2013 to June 30, 2015. Patients who received piperacillin/tazobactam (extended spectrum) were compared with those who received either cefoxitin or ceftriaxone with metronidazole (narrow spectrum) after propensity matching on demographic and severity characteristics. Study outcomes were 30-day SSI and hospital revisit rates.. Of the 1389 patients included, 39.1% received piperacillin/tazobactam (range by hospital: 0% to 100%), and the remainder received narrow-spectrum agents. No differences in demographics or severity characteristics were found between groups following matching. In the matched analysis, the rates of SSI were similar between groups [extended spectrum: 2.4% vs narrow spectrum 1.8% (odds ratio, OR: 1.05, 95% confidence interval, 95% CI 0.34-3.26)], as was the rate of revisits [extended spectrum: 7.9% vs narrow spectrum 5.1% (OR: 1.46, 95% CI 0.75-2.87)].. Use of extended-spectrum antibiotics was not associated with lower rates of SSI or hospital revisits when compared with narrow-spectrum antibiotics in children with uncomplicated appendicitis. Our results challenge the routine use of extended-spectrum antibiotics observed at many hospitals, particularly given the increasing incidence of antibiotic-resistant organisms.

Topics: Adolescent; Anti-Bacterial Agents; Appendectomy; Appendicitis; Cefoxitin; Ceftriaxone; Child; Child, Preschool; Comparative Effectiveness Research; Drug Therapy, Combination; Female; Humans; Male; Metronidazole; Patient Readmission; Piperacillin, Tazobactam Drug Combination; Propensity Score; Retrospective Studies; Surgical Wound Infection; Treatment Outcome

Single-incision laparoscopic appendectomy (SILA) has a higher rate of wound infection than the multiport technique. The purpose of this project was to determine whether the use of topical antibiotic powder reduces surgical site infections (SSIs) in pediatric patients who undergo SILA.. Patients aged 0-21 years who underwent SILA for acute appendicitis from April 2015 to November 2016 were included in this quality improvement initiative. Cefoxitin powder was placed in the umbilical wound before skin closure. Data were prospectively collected and outcome measures were compared with a historical cohort who underwent SILA before the implementation of antibiotic powder.. There were 108 patients in the historical group (HIST) and 126 in the powder group (POWD). The groups were similar in age (HIST: 11.5 ± 3.6 versus POWD: 12.2 ± 3.7 years, P = .15) and body mass index percentile (HIST: 57.6 ± 30.7 versus POWD: 58.8 ± 27.8, P = .84). Operative time was longer in the powder group (HIST: 26.5 ± 7.5 versus POWD: 29.7 ± 8.9 minutes, P = .004). Length of stay (HIST: 0.2 ± 0.4 versus POWD: 0.1 ± 0.4 days, P = .06), 30-day return to emergency department (HIST: 7% versus POWD: 8%, P = 1.0), and hospital readmissions (HIST: 5% versus POWD: 2%, P = .8) were similar. There was a significantly lower rate of superficial SSIs in the powder group (HIST: 4.6% versus POWD: 0%, P = .02).. In pediatric patients undergoing SILA for acute appendicitis, the use of cefoxitin powder in the umbilical wound is a simple intervention to reduce the incidence of superficial SSIs.

Topics: Acute Disease; Administration, Topical; Adolescent; Anti-Bacterial Agents; Appendectomy; Appendicitis; Cefoxitin; Child; Female; Humans; Laparoscopy; Length of Stay; Male; Operative Time; Patient Readmission; Powders; Surgical Wound Infection; Treatment Outcome; Umbilicus

Appendicitis is a common surgical emergency in pediatric patients, and broad-spectrum antibiotic therapy is warranted in their care. A simplified once-daily regimen of ceftriaxone and metronidazole (CTX plus MTZ) is cost effective in perforated patients. The goal of this evaluation is to compare a historic regimen of cefoxitin (CFX) in nonperforated cases and ertapenem (ERT) in perforated and abscessed cases with CTX plus MTZ for all cases in terms of efficacy and cost.. A retrospective review compared outcomes of nonperforated, perforated, and abscessed cases who received the historic regimen or CTX plus MTZ. Length of stay, time to afebrile, time to full feeds, postoperative abscess, and wound infection rates, inpatient readmissions, and antibiotic costs were evaluated.. There were a total of 841 cases reviewed (494 nonperforated, 247 perforated, and 100 abscessed). Overall, the CTX plus MTZ group had a shorter time to afebrile (P < .001). Treatment groups did not differ in length of stay. Postoperative abscess rates were similar between groups (4.1% vs 3.3%, not significant). Other postoperative complications were similar between groups. Total antibiotic cost savings were over $110 000 during the study period (from November 2010 to June 2013).. Both CFX and/or ERT and CTX plus MTZ result in low abscess and complication rates, suggesting both are effective strategies. Treatment with CTX plus MTZ results in a shorter time to afebrile, while also providing significant antibiotic cost savings. Ceftriaxone plus MTZ is a streamlined, cost-effective regimen in the treatment of nonperforated, perforated, and abscessed appendicitis.

Topics: Abdominal Abscess; Adolescent; Appendectomy; Appendicitis; beta-Lactams; Cefoxitin; Ceftriaxone; Child; Child, Preschool; Cost Savings; Cost-Benefit Analysis; Drug Administration Schedule; Drug Substitution; Drug Therapy, Combination; Ertapenem; Female; Humans; Infant; Laparoscopy; Male; Metronidazole; Retrospective Studies; Treatment Outcome; Young Adult

Topics: Abdominal Abscess; Appendicitis; Cefoxitin; Ceftriaxone; Cefuroxime; Child; Community-Acquired Infections; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Metronidazole; Pseudomonas; Pseudomonas Infections; Randomized Controlled Trials as Topic

The data from this study indicate that cefoxitin was effective and generally well tolerated in the management of gangrenous and/or perforated appendicitis. No strong correlation was identified between in vitro susceptibility testing results and clinical outcome.

Topics: Appendicitis; Bacteroides fragilis; Cefoxitin; Ceftizoxime; Double-Blind Method; Gangrene; Humans; Intestinal Perforation; Microbial Sensitivity Tests; Prospective Studies; Rupture, Spontaneous

The third day temperature is frequently used in the decision whether to continue or terminate antibiotic treatment following appendicectomy in perforated appendicitis. To assess the value of the third day temperature in predicting intraperitoneal infectious complications we studied 235 consecutive patients treated with a 3-day course of cefoxitin after surgery for perforated appendicitis. The results demonstrated that regardless of the level of elevated temperature chosen, the predictive value ranged between 16 and 33%. In consequence, elevated third day temperature per se does not provide any rational basis for continuing antibiotic treatment in order to prevent intraperitoneal infectious complications following appendectomy in perforated appendicitis.

Topics: Abdomen; Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Appendectomy; Appendicitis; Body Temperature; Cefoxitin; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Intestinal Perforation; Male; Middle Aged; Postoperative Complications; Surgical Wound Infection; Time Factors

Patients with gangrenous or perforated appendicitis were treated with cefoxitin or a combination of clindamycin and gentamicin for a minimum of five post-operative days. Septic complications developed in four of the 54 patients receiving cefoxitin: one was an intraabdominal abscess requiring surgery and three were wound infections. Of the 51 patients receiving clindamycin-gentamicin, two had septic complications: one was an intra-abdominal abscess requiring surgery and one was a wound abscess requiring drainage. The differences in the septic complications in the two treatment groups were not statistically significant. The cost to the patient of combined therapy with clindamycin and gentamicin was 36% higher than the cost of cefoxitin alone. The results demonstrate that cefoxitin alone is comparable to the "gold standard" of clindamycin-gentamicin in the treatment of patients with gangrenous or perforated appendicitis.

Topics: Adolescent; Adult; Aged; Appendectomy; Appendicitis; Appendix; Cefoxitin; Child; Child, Preschool; Clindamycin; Drug Therapy, Combination; Female; Gangrene; Gentamicins; Humans; Infusions, Intravenous; Intestinal Perforation; Male; Middle Aged; Surgical Wound Infection

This study was undertaken to assess the efficacy and safety of a 3-day course of treatment with Mefoxitin (cefoxitin sodium, MSD) in patients with perforated or ruptured appendicitis. A series of 235 patients undergoing surgery for perforated or ruptured appendicitis were treated with cefoxitin for 3 days. Twenty-four patients (10%) developed wound infection and 28 (12%) developed an intra-abdominal abscess postoperatively. No side effects were observed during the study. Compared with the results of our previous series, where a 5-day course of cefoxitin was used, the incidence of wound infection was similar. However the incidence of intra-abdominal abscesses in the present series was significantly higher (p less than 0.01). The results seem to indicate that a 3-day course of cefoxitin is as effective as a 5-day course in controlling the incidence of wound infection following surgery for perforated or ruptured appendicitis, whereas the 3-day course seems to be inferior to a 5-day course in controlling the incidence of intra-abdominal abscesses.

Topics: Abscess; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Appendicitis; Cefoxitin; Child; Child, Preschool; Female; Humans; Intestinal Perforation; Male; Middle Aged; Rupture, Spontaneous; Surgical Wound Infection

Appendicitis remains one of the commonest paediatric surgical emergencies in a busy paediatric surgical practice. In spite of improved diagnostic skills and surgical care, the incidence of severe appendicitis has remained unaltered in children over the past few decades and therefore remains a therapeutic challenge. A protocol for the treatment of severe appendicitis was instituted in the Division of Paediatric Surgery at the Royal Canberra Hospital by the author from 1981 to 1984 inclusive, and the results of treatment according to the protocol are presented. The results suggest that an aggressive approach to gangrenous and perforated appendicitis can result in very low morbidity from sepsis. The protocol is discussed.

Topics: Acute Disease; Appendectomy; Appendicitis; Cefoxitin; Child; Drug Therapy, Combination; Humans; Metronidazole; Postoperative Care; Premedication; Surgical Wound Infection

Topics: Abdomen; Abscess; Adult; Appendectomy; Appendicitis; Bacteroides fragilis; Bacteroides Infections; Cefoxitin; Diagnosis, Differential; Humans; Male; Pain

Twenty one cases of appendiceal peritonitis in children are reviewed. An antibiotic (sodium cefoxitine) has been used during the post-operative course to decrease the risk of suppurative complications. Cultures obtained from peritoneal exudate yielded "E. coli" and "Bacteroides" sp. as the most commonly isolated bacteria. External drainage was placed as a rutine and the percentage of suppurative complications was 14%. No patient showed evidence of adverse reactions to the antibiotic and the mortality of the serie was zero. Obtained results allow to state that cefoxitine is effective in the management of appendiceal peritonitis in children.

Topics: Appendicitis; Ascitic Fluid; Cefoxitin; Child; Drainage; Humans; Peritonitis; Postoperative Complications; Rupture, Spontaneous

Topics: Appendicitis; Cefoxitin; Child; Humans; Peritonitis