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The Use of Single-Agent Antibacterial Regimens in the Treatment of Advanced Appendicitis with Peritonitis

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Summary

The optimal antibacterial regimen for the treatment of patients with mixed intra-abdominal infections remains to be established. Since advanced (gangrenous and perforated) appendicitis with peritonitis probably represents the most reproducible clinical model of this disease process, we performed a randomised double-blind study comparing 2 single-agent regimens (ceftizoxime 2g every 12 hours and cefoxitin 2g every 6 hours) in the treatment of advanced appendicitis with peritonitis. 109 evaluable patients (84 male, 25 female) aged 12 to 70 (mean 28) years were randomised, 53 to ceftizoxime and 56 to cefoxitin. 75 patients (69%) had perforation and 34 (31%) exhibited gangrene, with the mean duration of abdominal pain and mean white blood cell (WBC) count on admission being significantly greater in the group with perforation [71 vs 46 hours and 16.9 vs 14.8 ×109/L, respectively (p < 0.05)]. Bacteria were recovered from the peritoneal cultures of all patients, with a mean of 3.3 aerobes and 8.8 anaerobes per specimen, representing a 600% increase in bacterial recovery compared with previous reports. The clinical cure rate was 51 of 53 (96%) for ceftizoxime vs 47 of 56 (84%) for cefoxitin (p = 0.06), or 90% overall. We conclude that single-agent antibacterial therapy with either of these 2 drugs is safe and very effective in patients with advanced appendicitis with peritonitis, and that the number of bacteria associated with this condition is much greater than previously believed.

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Authors and Affiliations

  1. Department of Surgery, Olive View Medical Center and UCLA School of Medicine, Los Angeles, California, USA

    Robert S. Bennion, J. E. Thompson Jr & P. J. Schmit

  2. Medical Services, VA Wadsworth Medical Center, Los Angeles, California, USA

    S. M. Finegold

  3. Research Services, VA Wadsworth Medical Center, Los Angeles, California, USA

    E. J. Baron & S. M. Finegold

  4. Department of Medicine, UCLA School of Medicine, Los Angeles, California, USA

    E. J. Baron & S. M. Finegold

  5. Department of Microbiology and Immunology, UCLA School of Medicine, Los Angeles, California, USA

    S. M. Finegold

Authors
  1. Robert S. Bennion
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  2. J. E. Thompson Jr
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  3. E. J. Baron
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  4. P. J. Schmit
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  5. S. M. Finegold
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Bennion, R.S., Thompson, J.E., Baron, E.J. et al. The Use of Single-Agent Antibacterial Regimens in the Treatment of Advanced Appendicitis with Peritonitis. Drug Invest 4 (Suppl 1), 7–12 (1992). https://doi.org/10.1007/BF03258337

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