[Erythromycin and latamoxef in the initial treatment of diffuse peritonitis with visceral failure].
In a thirty months prospective study, 61 patients treated in an Intensive Care Unit received erythromycin (E) (3 g/24 h) and latamoxef (L) (2 g/24 h) as soon as acute peritonitis was surgically confirmed. Five days later, E + L were stopped and nitro-imidazol (NI) was prescribed while searching for a possible infection. The severity of the illness was assessed by clinical study of organ failures and by use of the Simplified Acute Physiology Score (SAPS). 21 patients died (34%): among them 8 of the 19 with postoperative peritonitis. Average SAPS was 17.8 (+/- 4.1) while it was 13 in 631 ICU treated patients (mortality: 22%). Every patient needed mechanical ventilation; pré or per-operative shock has been noted in 41 (67%) and 27 had developed acute renal failure (44%). During E + L, 6 patients died because of an irreversible shock and twice the treatment was not efficient on the isolated bacteria (Pseudomonas aeruginosa, Staphylococcus). No more shock developed post-operatively. During NI, 11 secondary infections (20%) were diagnosed (bacteremia = 6, urinary tractus infection = 4, reactivated arthritis = 1). The bacteria were Streptococcus (n = 6) with Enterococcus (n = 5), Staphylococcus (n = 3) and Pseudomonas aeruginosa (n = 2): they were still respectively sensitive to ampicillin, methicillin and ticarcillin. The association E + L was clinically and biologically well tolerated.
Godard
J
J
Service de Réanimation, Hôpital Edouard-Herriot, Lyon.
Reverdy
M E
ME
Mahul
P
P
Perrot
D
D
Fond
G
G
Motin
J
J
D000208:Acute Disease; D058186:Acute Kidney Injury / Q000150:complications; D000328:Adult; D000368:Aged; D004359:Drug Therapy, Combination; D004917:Erythromycin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009070:Moxalactam / Q000008:administration & dosage*; D009102:Multiple Organ Failure / Q000150:complications*; D010538:Peritonitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology
D004917:Erythromycin; D009070:Moxalactam
Erythromycine et latamoxef en traitement d'attaque des péritonites diffuses avec défaillances viscérales.