Rodriguez J C, Buckner D, Schoenike S, Gomez-Marin O, Oiticica C, Thompson W R
Department of Pediatric Pharmacy Services, Jackson Children's Hospital, Miami, Florida, USA.
Int J Clin Pharmacol Ther. 2000 Oct;38(10):492-9. doi: 10.5414/cpp38492.
An increased incidence of post-surgical infectious complications in children admitted with a diagnosis of perforated appendicitis led to development of a disease-specific antibiogram and modification of our post-operative antibiotic regimen.
A historical control group comprised of 32 pediatric patients receiving ampicillin, gentamicin, and clindamycin (group AGC) was compared to a cohort of 32 children receiving ticarcillin/clavulanate plus gentamicin (group TG). The surgical procedure, peri-operative management, and inclusion, exclusion and discharge criteria were the same for each group. Outcome measures including length of stay, time to defervesce, incidence of infectious complications, and clinical failures to the antibiotic regimen were compared.
The groups were similar with respect to gender, age, weight, surgical time, pre-operative leukocytes, and number of intra-operative bacterial isolates cultured per patient. Length of stay was 10.1 days in group TG and 12.5 days for group AGC (p = 0.0197). The number of clinical failures was reduced from 9 (28.1%) to 2 (6.3%) in group TG (p = 0.02). The time to defervesce was decreased by 1.4 days, and the number of infectious complications was reduced to 2.5-fold in group TG patients.
Ticarcillin/clavulanate plus gentamicin was clinically more effective than ampicillin, gentamicin, and clindamycin combination therapy in the management of perforated appendicitis in our pediatric population.
诊断为穿孔性阑尾炎的儿童术后感染并发症发生率增加，促使我们制定了针对该疾病的抗菌谱，并对术后抗生素治疗方案进行了调整。
将32例接受氨苄西林、庆大霉素和克林霉素治疗的儿科患者组成的历史对照组（AGC组）与32例接受替卡西林/克拉维酸加庆大霉素治疗的儿童队列（TG组）进行比较。两组的手术操作、围手术期管理以及纳入、排除和出院标准均相同。比较了包括住院时间、退热时间、感染并发症发生率以及抗生素治疗方案的临床失败情况等结果指标。
两组在性别、年龄、体重、手术时间、术前白细胞计数以及每位患者术中培养的细菌分离株数量方面相似。TG组的住院时间为10.1天，AGC组为12.5天（p = 0.0197）。TG组的临床失败数量从9例（28.1%）降至2例（6.3%）（p = 0.02）。TG组患者的退热时间缩短了1.4天，感染并发症数量减少至2.5倍。
在我们的儿科人群中，替卡西林/克拉维酸加庆大霉素在治疗穿孔性阑尾炎方面在临床上比氨苄西林、庆大霉素和克林霉素联合治疗更有效。
