PROSPECTIVE RANDOMIZED STUDY OF 2 DIFFERENT DOSES OF CLINDAMYCIN ADMIXED WITH GENTAMICIN IN THE MANAGEMENT OF PERFORATED APPENDICITIS

Septic complications after surgery for enterogenous peritonitis are mi nimized by adjuvant antibiotics effective against aerobes and anaerobe s. Historically, ''gold standard' therapy included an aminoglycoside p lus clindamycin, the latter given at 600 mg intravenous piggyback (IVP B), every 6 hours. Clindamycin pharmacokinetics suggests that it can b e given q8h and admixed with gentamicin, thereby markedly reducing the cost of administration. Although this is now common practice, there i s no prospective study comparing the efficacy of the two dose schedule s in peritonitis. This study was designed to test the hypothesis regar ding the clinical efficacy of the two regimens. One hundred twenty-six patients with gangrenous (n = 34) or perforated appendicitis (n = 91) were randomized (2:1) to receive gentamicin admixed with clindamycin 900 mg IVPB every 8 hours (Group I n = 80) or gentamicin IVPB q8h plus clindamycin 600 mg IVPB every 6 hours (Group II n = 46). Appendectomy was performed, and aerobic and anaerobic cultures were obtained. Twen ty-one patients had simultaneous determinations of clindamycin levels in plasma, peritoneal fluid, and appendix. Outcome analysis revealed n o significant differences in postoperative days of fever, days non per os, antibiotic therapy, or hospitalization. There were 6 failures (4 abscesses and 2 wound infections) in Group I and 4 failures (1 abscess and 3 wound infections) in Group II. Both antibiotic regimens provide d clinically equivalent results in mixed infections due to aerobic and anaerobic bacteria. The admixed clindamycin, administered every 8 hou rs, results in at least 20% reduction in costs. This is an important c onsideration.