ANTIBIOTIC-THERAPY OF PERFORATED APPENDIC ITIS IN CHILDREN - A COMPARISON OF AMOXICILLIN-CLAVULANATE WITH A COMBINATION OF BENZYLPENICILLIN, NETILMICIN AND METRONIDAZOLE

In a multicentre trial we compared the clinical efficacy of amoxicilli n/clavulanate used as a single-agent therapy with that of the three-ag ent combination usually prescribed in the post-operative period for ap pendicular peritonitis in children. Only bacteriologically documented peritoneal infections were included. Sixty-four patients were randomly distributed between two groups: Group A (29 cases) treated with amoxi cillin/clavulanate, first administered iv (100 mg/kg/d), followed by c onversion to the oral route (50 mg/kg/d) once the patient had been afe brile for 48 hours; Group B (35 cases) first treated by the iv route w ith benzylpenicillin (100,000 IU/kg/d) plus netilmicin (5 mg/kg/d) plu s metronidazole (30 mg/kg/d), followed by conversion to the oral route for metronidazole (30 mg/kg/d). In both groups, the total duration of parenteral and oral treatment was not less than 5 days. One hundred a nd seventy nine bacterial strains were recovered from peritoneal fluid samples obtained during surgery; 86% of these were sensitive to amoxi cillin/clavulanate. Clinical efficacy, assessed on the basis of time u ntil return to normal temperature and gut transit and duration of hosp italization, was identical in both groups, with follow-up monitoring o n day 30 showing recovery in all cases. Cure was obtained without any problems of infection in 25/29 patients in group A and in 34/35 patien ts in group B (non significant difference). Tolerance was excellent an d identical in the two groups with the exception of three cases of thr ombophlebitis which occurred in group B. The results of this study sug gest that amoxicillin/clavulanate may be useful as single-agent therap y as a first-line curative treatment for appendicular peritonitis in c hildren.