title: [Antibiotherapy in gangrene of the perineum].
abstract: Fifty cases of extensive and necrotizing perineal cellulitis ("perineal gangrene") are reported. The disease, remarkable for its many anatomical and bacteriological varieties, is regarded as a therapeutic requiring multidisciplinary management. Bacteriological samples were polymicrobial in 40 cases. Streptococcus D and aerobic Gram-negative bacilli were isolated in 21 patients. The initial antibiotic treatment had to be modified on ten occasions in 36 patients who were given penicillin G in high doses and on five occasions in 14 patients who received a beta-lactam antibiotic active against anaerobes. Nineteen patients (38 p. 100) died; death was directly related to the sepsis in 16 cases. The death rate was the same in the two treatment groups (11/36 and 5/14) and similar to that found in the literature. The authors advocate an ureidopenicillin, fosfomycin and imidazole combination as a substitute for the conventional penicillin G, aminoglycoside, imidazole combination, since the former is active against Streptococcus D and has better tissue penetration.
authors.affiliation: Service de Réanimation médicale et d'Hyperbarie, Hpital Salvator, Marseille.
authors.forename: J
authors.initials: J
authors.lastname: Durand-Gasselin
authors.forename: P
authors.initials: P
authors.lastname: Van Gaver
authors.forename: J
authors.initials: J
authors.lastname: Benzenou
authors.forename: M N
authors.initials: MN
authors.lastname: Mallet
authors.forename: E
authors.initials: E
authors.lastname: Bergmann
authors.forename: J M
authors.initials: JM
authors.lastname: Sainty
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001421:Bacteria, Anaerobic; D001424:Bacterial Infections; D002481:Cellulitis / Q000188:drug therapy* / Q000628:therapy; D004359:Drug Therapy, Combination; D005260:Female; D005578:Fosfomycin / Q000627:therapeutic use; D005734:Gangrene / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D006931:Hyperbaric Oxygenation; D007093:Imidazoles / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000627:therapeutic use; D010502:Perineum
chemical_list: D007093:Imidazoles; D005578:Fosfomycin; D010400:Penicillin G
vernacular_title: L'antibiothérapie dans les gangrènes du périnée.