title: Antibiotic therapy of perforated appendicitis in children: a comparison of amoxycillin/clavulanate with a combination of benzylpenicillin, netilmicin and metronidazole.
abstract: This multicentre trial compared the clinical efficacy of amoxycillin/clavulanate used as a single-agent therapy with that of the three-agent combination usually prescribed in the post-operative period for appendicular peritonitis in children. Only bacteriologically documented peritoneal infections were included. Sixty-four patients were randomly distributed between two groups: Group A (29 cases) treated with amoxycillin/clavulanate, first administered iv (100 mg/kg/day) followed by conversion to the oral route (50 mg/kg/day) once the patient had been afebrile for 48 h; Group B (35 cases) first treated by the iv route with benzylpenicillin (100,000 IU/kg/day) plus netilmicin (5 mg/kg/day) plus metronidazole (30 mg/kg/day) followed by conversion to the oral route for metronidazole (30 mg/kg/day). In both groups, the total duration of parenteral and oral treatment was not less than five days. A total of 180 bacterial strains were recovered from peritoneal fluid samples obtained during surgery; 86% of these were sensitive to amoxycillin/clavulanate. Clinical efficacy, assessed on the basis of time until return to normal temperature and gut transit and duration of hospitalization, was identical in both groups, with follow-up monitoring on day 30 showing recovery in all cases. Cure was obtained without any problems of infection in 25/29 patients in group A and in 34/35 patients in group B (non-significant difference). Tolerance was excellent and identical in the two groups with the exception of three cases of thrombophlebitis which occurred in group B. The results of this study suggest that amoxycillin/clavulanate may be useful as single-agent therapy as a first-line curative treatment for appendicular peritonitis in children.
authors.affiliation: Chirurgie Pédiatrique, Hôpital des Enfants, Nancy, France.
authors.forename: M
authors.initials: M
authors.lastname: Schmitt
authors.forename: J M
authors.initials: JM
authors.lastname: Bondonny
authors.forename: P
authors.initials: P
authors.lastname: Delmas
authors.forename: R B
authors.initials: RB
authors.lastname: Galifer
authors.forename: Y
authors.initials: Y
authors.lastname: Revillon
authors.forename: M
authors.initials: M
authors.lastname: Robert
authors.forename: A
authors.initials: A
authors.lastname: Janin
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use*; D001064:Appendicitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D002969:Clavulanic Acids / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D009428:Netilmicin / Q000627:therapeutic use*; D010400:Penicillin G / Q000627:therapeutic use*; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology; D011184:Postoperative Period; D016032:Randomized Controlled Trials as Topic
chemical_list: D002969:Clavulanic Acids; D008795:Metronidazole; D009428:Netilmicin; D000658:Amoxicillin; D010400:Penicillin G