Meropenem versus tobramycin with clindamycin in the antibiotic management of patients with advanced appendicitis.

Abstract

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 clinical advantages.

STUDY DESIGN:

We compared patients with advanced appendicitis (gangrenous or perforated) treated with 1,000 mg MP every eight hours with those given the combination of tobramycin 5 mg/kg/day at eight hour intervals and clindamycin 900 mg every eight hours. Both treatments 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 mean number of days of postoperative fever (MP = 3.1 +/- 1.7 SD compared to T/C = 4.4 +/- 2.2 SD, p < or = 0.01), days of antibiotic therapy (MP = 6.1 +/- 1.6 SD compared 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 the numbers of failures in each group (MP = 5 compared to T/C = 6).

CONCLUSIONS:

This study demonstrates a small but significant reduction (approximately one day) in post-operative fever, duration of antibiotic treatment, and hospital stay for patients treated with MP compared to those treated with T/C.

• Authors: T V Berne, A E Yellin, M D Appleman, P N Heseltine, M A Gill
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 182 Issue 5 Pg. 403-7 (May 1996) ISSN: 1072-7515 [Print] United States
• PMID: 8620275 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Thienamycins
• Clindamycin
• Meropenem
• Tobramycin

Topics

• Adult
• Anti-Bacterial Agents (administration & dosage, therapeutic use)
• Appendicitis (drug therapy)
• Clindamycin (administration & dosage, therapeutic use)
• Double-Blind Method
• Drug Administration Schedule
• Drug Therapy, Combination (administration & dosage, therapeutic use)
• Female
• Humans
• Intestinal Perforation (drug therapy)
• Length of Stay
• Male
• Meropenem
• Rupture, Spontaneous
• Thienamycins (therapeutic use)
• Time Factors
• Tobramycin (administration & dosage, therapeutic use)