World Journal of Surgery

, Volume 4, Issue 4, pp 415–420 | Cite as

Clinical comparison of antibiotic combinations in the treatment of peritonitis and related mixed aerobic-anaerobic surgical sepsis

  • H. Harlan Stone
  • Timothy C. Fabian


Patients with presumed mixed aerobic-anaerobic peritoneal (126) or soft tissue (59) sepsis were treated with 1 of 3 randomly assigned antibiotic regimens: gentamicin plus clindamycin (68), gentamicin plus metronidazole (60), and cefamandole plus erythromycin (60). Primary and complicating foci of infection were cultured for both aerobic and anaerobic pathogens and antibiotic sensitivities were determined. In vitro aerobic and anaerobic sensitivities were, respectively: 80% and 70% for cefamandole, 10% and 64% for clindamycin, 31% and 91% for erythromycin, 83% and 0% for gentamicin, and 1% and 87% for metronidazole. Similar control of primary infection was obtained with each regimen (95%), although recurrence of sepsis was least common after treatment with gentamicin-metronidazole (3%,p+<0.05) in contrast to gentamicin-clindamycin (19%) and cefamandole-erythromycin (15%). Significant complications were hypoprothrombinemia, occurring only after cefamandole-erythromycin therapy (5%), and acute renal failure, found almost exclusively with gentamicin treatment (10%,p=< 0.01), and accounting for 3 deaths. Unremitting sepsis caused 3 deaths. There were 5 deaths due to complications not related to the mode of therapy. These results suggest the relative safety of cefamandole, superiority of metronidazole for anaerobes, and frequent life-threatening nephrotoxicity of gentamicin.


Gentamicin Erythromycin Peritonitis Acute Renal Failure Metronidazole 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Des patients chez qui l’on soupçonnait une infection péritonéale (126 malades) ou des tissus mous (59) à mélange de germes aérobies et anaérobies ont été répartis au hasard selon 3 programmes d’antibiothérapie: gentamycine et clindamycine (68 cas), gentamycine et métronidazole (60 cas), céfamandole et érythromycine (60 cas). Les cultures aérobies et anaérobies ont été faites dans les foyers d’infection primaires et secondaires, avec antibiogramme. Les sensibilités in vitro étaient: 80% des germes anaérobies et 70% des anaérobies pour la céfamandole, 10% et 64% pour la clindamycine, 31% et 91% pour l’érythromycine, 83% et 0% pour la gentamycine, 1% et 87% pour le métronidazole. Les trois schémas thérapeutiques ont permis de contrôler les foyers infectieux primitifs dans 95% des cas, mais les récidives d’infection ont été plus rares sous gentamycine-métronidazole (3%,p<0.05) que sous gentamycine-clindamycine (19%) et sous céfamandole-érythromycine (15%). Les complications graves ont été l’hypoprothrombinémie, uniquement après céfamandole-érythromycine (5%) et l’insuffisance rénale aiguë, presque exclusivement après gentamycine (10%,p<0.01) et responsables de 3 décès. La persistance de l’infection a été cause de 3 autres décès. Cinq décès sont dus à des complications indépendantes de la thérapeutique. Ces résultats suggèrent que la céfamandole est peu toxique, que le métronidazole est le meilleur antibiotique pour les anaérobies et que la gentamycine est souvent gravement néphrotoxicique.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gorbach, S.L., Bartlett, J.G.: Anaerobic infections. N. Engl. J. Med.296:1177, 1237, 1269, 1974CrossRefGoogle Scholar
  2. 2.
    Stone, H.H., Kolb, L.D., Geheber, C.E.: Incidence and significance of intraperitoneal anaerobic bacteria. Ann. Surg.181:705, 1975PubMedGoogle Scholar
  3. 3.
    Appel, G.B., Neu, H.C.: The nephrotoxicity of antimicrobial agents. N. Engl. J. Med.296:663, 722, 784, 1977PubMedCrossRefGoogle Scholar
  4. 4.
    Stone, H.H., Guest, B.S., Geheber, C.E., Kolb, L.D.: Cefamandole in the treatment of peritonitis. J. Infect. Dis.137:S103, 1978Google Scholar
  5. 5.
    Griffith, R.S., Brier, G.L., Wolny, J.D.: Synergistic action of erythromycin and cefamandole against Bacteroides fragilis, subspecies fragilis. Antimicrob. Agents Chemother.11:813, 1977PubMedGoogle Scholar
  6. 6.
    Finegold, S.M., McFadzean, J.A., Roe, F.J.C., editors: International Metronidazole Conference, Montreal, 1976. Metronidazole: Proceedings of the International Metronidazole Conference, Montreal, Quebec, Canada, May 26–28, 1976. Amsterdam, Excerpta Medica, 1977Google Scholar
  7. 7.
    Altemeier, W.A.: The bacterial flora of acute perforated appendicitis with peritonitis. Ann. Surg.107:517, 1938PubMedGoogle Scholar
  8. 8.
    Stone, H.H., Hester, T.R., Jr.: Incisional and peritoneal infection after emergency celiotomy. Ann. Surg.177:669, 1973PubMedGoogle Scholar
  9. 9.
    Stone, H.H., Kolb, L.D., Geheber, C.E., Dawkins, E.J.: Use of aminoglycosides in surgical infections. Ann. Surg.183:660, 1976PubMedGoogle Scholar
  10. 10.
    Stone, H.H., Morris, E.S.: Perspectives in the treatment of bacterial peritonitis. In Surgical Sepsis, Strachan, C.J.L., Wise, R., editors, London, Academic Press, 1979, pp. 59–67Google Scholar

Copyright information

© Société Internationale de Chirurgie 1980

Authors and Affiliations

  • H. Harlan Stone
    • 1
  • Timothy C. Fabian
    • 1
  1. 1.Department of SurgeryEmory University School of MedicineAtlantaUSA

Personalised recommendations