cefoxitin and Intestinal-Perforation

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

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

A randomized, double-blind study of cefoxitin (CX) or clindamycin/gentamicin (CG) as adjuncts to the surgical management of peritonitis is reported. Groups with similar infection risks were evaluated by including only patients with abdominal stab wounds, enteric injury, and spillage of the gastrointestinal contents. One hundred ninety-five patients were entered of whom 75 were evaluable. Comparisons of the ages, sex, diagnoses, and measures of outcome were not significantly different. Fifteen per cent (5/34) of CX treated patients had postoperative complications (three infections) vs. 10% (4/41) of patients treated with CG (three infections). Intraperitoneal bacteria were cultured from 62% of CX and 59% of CG patients. Antibiotic resistance, seen in three patients of each group, was not associated with failure. Two moderately sensitive Bacteroides distasonis were each associated with a failure in the CX and CG groups. We deduce that both regimens are effective and that cefoxitin may represent less costly single-agent therapy.

Topics: Adolescent; Adult; Bacteria; Cefoxitin; Clindamycin; Double-Blind Method; Drug Resistance, Microbial; Female; Gentamicins; Humans; Intestinal Perforation; Male; Middle Aged; Peritoneal Cavity; Peritonitis; Premedication; Random Allocation; Wounds, Stab

To identify the risk factors for the development of postoperative septic complications in patients with intestinal perforation after abdominal trauma, and to compare the efficacies of single-drug and dual-drug prophylactic antibiotic therapy, we studied 145 patients who presented with abdominal trauma and intestinal perforation at two hospitals between July 1979 and June 1982. Logistic-regression analysis showed that a higher risk of infection (P less than 0.05) was associated with increased age, injury to the left colon necessitating colostomy, a larger number of units of blood or blood products administered at surgery, and a larger number of injured organs. The presence of shock on arrival, which was found to increase the risk of infection when this factor was analyzed individually, did not add predictive power. Patients with postoperative sepsis were hospitalized significantly longer than were patients without infection (13.8 vs. 7.7 days, P less than 0.0001). Both treatment regimens--cefoxitin given alone and clindamycin and gentamicin given together--resulted in similar infection rates, drug toxicity, duration of hospitalization, and costs.

Topics: Abdominal Injuries; Adult; Age Factors; Bacterial Infections; Blood Transfusion; Cefoxitin; Clindamycin; Colon; Drug Therapy, Combination; Female; Gentamicins; Humans; Intestinal Perforation; Male; Prospective Studies; Risk; Shock, Traumatic; Wound Infection; Wounds, Penetrating

Ingested foreign bodies rarely cause gastrointestinal perforation, because the majority are passed out uneventfully in the feces. However, long, sharp, slender, hard, indigestible objects such as toothpicks are dangerous and may lead to potentially life-threatening complications. We report a case of duodenal perforation caused by a toothpick and complicated by liver abscess and methicillin-resistant Staphylococcus aureus sepsis. Although laparotomy was not performed because of the patient's refusal to undergo surgery, the liver abscess and sepsis were controlled successfully with antibiotics. We also conducted a literature search for reports on injuries caused by ingested toothpicks.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Bacteremia; Cefoxitin; Duodenum; Follow-Up Studies; Foreign-Body Migration; Humans; Intestinal Perforation; Liver; Liver Abscess; Male; Methicillin Resistance; Metronidazole; Middle Aged; Staphylococcal Infections; Tomography, X-Ray Computed; Ultrasonography; Vancomycin

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