Tobramycin clindamycin vs. cephalothin cephalexin in the treatment of appendicular peritonitis
Gripenberg, L.; Nuutinen, P.; Elo, J.; Tallgren, L.G.
Zeitschrift fuer Kinderchirurgie 34(3): 227-235
Forty-seven children, ages 1-14 yr, with appendicular peritonitis were randomly divided into 2 groups: 27 treated with the combination tobramycin-clindamycin and 20 with cephalothin followed by cephalexin. The overall rate of complications was 32%. Patients who had had their symptoms for less than 48 h before being hospitalized had significantly fewer complications than those whose symptoms had lasted longer. Patients treated with tobramycin-clindamycin had significantly fewer wound infections. As clindamycin is effective against anaerobes this observation supports the view that anaerobes play an important role in the infectious complications in peritonitis. In this series, 12 spp. of aerobes and 8 spp. of anaerobes were cultured from peritoneal fluid. In 8 patients only one species was isolated; in the remaining 39 patients, 29 different combinations of bacteria were encountered. Early diagnosis and administration of antibiotics preoperatively or during surgery, including clindamycin, metronidazol or tinidazol is recommended in the treatment of children with appendicular peritonitis.