MEROPENEM VERSUS TOBRAMYCIN WITH CLINDAMYCIN IN THE ANTIBIOTIC MANAGEMENT OF PATIENTS WITH ADVANCED APPENDICITIS

BACKGROUND: Meropenem (MP), a new carbapenem antibiotic, has excellent antimicrobial activity against the enteric flora commonly encountered in acute appendicitis. Although similar to imipenem, it may have clin ical advantages. STUDY DESIGN: We compared patients with advanced appe ndicitis (gangrenous or perforated) treated with 1,000 mg MP every eig ht hours,vith those given the combination of tobramycin 5 mg/kg/day at eight hour intervals and clindamycin 900 mg every eight hours. Both t reatments were given intravenously. Patients were randomized to either group of the double-blind study. RESULTS: Of 129 evaluable cases, 63 received MP and 66 received both tobramycin and clindamycin (T/C). The two groups were similar in age, sex, and severity of disease. The mea n number of days of postoperative fever (MP=3+/-1.7 SD compared to T/C =4.4+/-2.2 SD, p=<0.01), days of antibiotic therapy (MP=6.1+/-1.6 SD c ompared to T/C=7.3+/-2.2 SD, p=0.01), and therefore hospital stay (MP= 8.0+/-3.5 SD compared to T/C=9.4+/-2.6 SD, p<0.01) were significantly better for patients treated with MP. No difference was found between t he numbers of failures in each group (MP=5 compared to T/C=6). CONCLUS IONS: This study demonstrates a small but significant reduction (appro ximately one day) in postoperative fever, duration of antibiotic treat ment, and hospital stay for patients treated with MP compared to those treated with T/C.