A CLINICAL COMPARISON OF CEFEPIME AND METRONIDAZOLE VERSUS GENTAMICINAND CLINDAMYCIN IN THE ANTIBIOTIC MANAGEMENT OF SURGICALLY TREATED ADVANCED APPENDICITIS

Many antibiotics and antibiotic combinations are used for the treatmen t of peritonitis because of advanced (gangrenous or perforated) append icitis. An aminoglycoside combined with an antianaerobe antibiotic is one standard treatment, but there is concern about the potential nephr otoxicity of the aminoglycoside and the necessity for monitoring amino glycoside blood levels. Cefepime, a new broad-spectrum cephalosporin w ith a prolonged serum half-life, has excellent activity against gram-p ositive and gram-negative bacteria, including Pseudomonas aeruginosa. Its spectrum of activity is similar to the aminoglycosides, but it has less potential for inducing renal injury. A double-blind, randomized study compared cefepime, 2 grams every 12 hours IVPB plus metronidazol e 0.5 grams every eight hours IVPB (C/M) with gentamicin 1.5 milligram s per kilograms of IVPB plus clindamycin 0.9 grams q eight hours IVPB (G/C), administered up to 14 days, in 96 surgically treated patients w ith gangrenous or perforated appendicitis. Fifty patients had advanced appendicitis (nine gangrenous and 41 perforated) in the C/M group and 46 patients (six gangrenous and 40 perforated) in the G/C group. The mean number of days of post-operative fever (C/M, 4.4 +/- 2.7 versus G /C, 5.0 +/- 2.2), postoperative hospitalization (C/M, 2.0 +/- 1.9 vers us G/C, 2.0 +/- 2.1) and antibiotic therapy (C/M, 6.3 +/- 1.9 versus G /C, 6.9 +/- 1.9) was similar in the two treatment groups. There were 1 1 treatment failures (C/M, three; G/C, eight; p=0.13), six of which we re probably a result of enterococci. No deaths occurred. Our study res ults show that the efficacy of cefepime plus metronidazole is equivale nt to that of clindamycin plus gentamicin.