Ceftriaxone/metronidazole is more effective than ampicillin/netilmicin/metronidazole in the treatment of bacterial peritonitis.
In a prospective, open, controlled clinical study, 190 consecutive patients who were thought to have bacterial peritonitis before operation, were randomised to antibiotic treatment during and after operation with either ceftriaxone 1 g plus metronidazole 1.5 g once daily (n = 94) or ampicillin 2 g plus netilmicin 150 mg twice daily plus metronidazole 1.5 g once daily (n = 96). Incisional and deep surgical wound infections, postoperative pneumonia and urinary tract infection as well as deaths caused by infection were recorded. Ceftriaxone-metronidazole was significantly more effective than ampicillin-netilmicin-metronidazole, 6/94 wound related infections (6%) compared to 18/96 (19%) (p = 0.02). In patients with peritonitis caused by a perforated colon or appendix the rates of clinical failure were 6% and 28%, respectively. We consider ceftriaxone plus metronidazole an efficient and easily administered antibiotic regimen in patients with bacterial peritonitis, and both the wide range of activity against Gram-negative aerobic rods and the long half life of ceftriaxone seem to be beneficial.
Luke
M
M
Department of Surgery, Sundby Hospital, Copenhagen, Denmark.
Iversen
J
J
Søndergaard
J
J
Kvist
E
E
Lund
P
P
Andersen
F
F
Naver
L
L
Larsen
P N
PN
Clausen
B
B
Prag
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D002443:Ceftriaxone / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004338:Drug Combinations; D006801:Humans; D015994:Incidence; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D009428:Netilmicin / Q000008:administration & dosage; D010538:Peritonitis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D015996:Survival Rate
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D008795:Metronidazole; D009428:Netilmicin; D002443:Ceftriaxone; D000667:Ampicillin