COMPARATIVE TRIAL OF 4 ANTIBIOTIC COMBINATIONS FOR PERFORATED APPENDICITIS IN CHILDREN

Objective: To compare the therapeutic efficacy of four antibiotic regi mens: penicillin, tobramycin, and clindamycin; penicillin, tobramycin, and ornidazole; piperacillin alone; and ceftriaxone and ornidazole in the treatment of children operated on for perforated appendicitis. De sign: Prospective randomised study. Setting: Teaching hospital, Turkey . Subjects: 200 patients aged between 1 and 16 years treated from Dece mber 1991 to December 1995 who were randomly assigned to one of four g roups each consisting of 50 patients. Interventions: Preoperative anti biotics given intravenously, peritoneal drainage by Penrose drains wit hout irrigation, appendicectomy with the inversion of the stump by a p urse string, taking peritoneal swabs, and primary skin closure. Main o utcome measures: Comparability of the groups, duration of fever, leuco cytosis, antibiotic treatment, stay in hospital, nasogastric intubatio n, and drainage, as well as results of cultures and complications. Res ults: There were no significant differences between the groups for any variable studied. The predominant bacterial species were Escherichia coli, Klebsiella spp, Pseudomonas spp, Fusobacteria, and Peptostreptoc occi which were appropriately covered by all the antibiotic regimens. Fourteen patients had complications including wound infections (n = 10 ), prolonged ileus (n = 2) and intra-abdominal abscess (n = 2) all of which were treated conservatively. There was no mortality and no major complications. All regimens had the same clinical and bacteriological efficacy. Conclusion: There is no gold standard for antimicrobial che motherapy in perforated appendicitis. Different antibiotic combination s or a single broad spectrum antibiotic, which include both aerobic an d anaerobic coverage, can safely be used in children with perforated a ppendicitis.