Jones J, Handler S D, Guttenplan M, Potsic W, Wetmore R, Tom L W, Marsh R
Division of Otolaryngology, Children's Hospital of Philadelphia, PA 19104.
Arch Otolaryngol Head Neck Surg. 1990 May;116(5):590-3. doi: 10.1001/archotol.1990.01870050090013.
Tonsillectomy and adenoidectomy continues to be one of the most commonly performed operations in the pediatric age group. The morbidity from tonsillectomy can be severe and includes throat and ear pain, fever, lethargy, and poor oral intake. A previous study at the Children's Hospital of Philadelphia (Pa) demonstrated the efficacy of amoxicillin therapy in minimizing some of these postoperative symptoms. However, some children continue to have a prolonged recovery even while receiving this antibiotic regimen. Because of these children and the high incidence of Staphylococcus found in tonsillar core tissue, a randomized, prospective study was undertaken at the Children's Hospital of Philadelphia to evaluate the efficacy of cefaclor vs amoxicillin in patients recovering from tonsillectomy. The patients received either ampicillin or cefazolin intravenously at the time of surgery and for 12 to 24 hours postoperatively. When oral intake was adequate, they received either amoxicillin or cefaclor orally for 7 additional postoperative days. Intraoperative cultures of the oropharynx and tonsillar tissue were obtained, as well as cultures of the tonsillar fossa 7 to 14 days postoperatively. The patients were evaluated for severity and duration of postoperative symptoms as well as complications. The results of this study showed no difference between the two groups of patients. We conclude that there is no justification for routine use of cefaclor over amoxicillin in the posttonsillectomy patient.
扁桃体切除术和腺样体切除术仍然是儿科最常开展的手术之一。扁桃体切除术后的发病率可能很严重，包括咽喉和耳部疼痛、发热、嗜睡以及进食不佳。费城儿童医院此前的一项研究证明了阿莫西林治疗在减轻部分术后症状方面的有效性。然而，一些儿童即便接受了这种抗生素治疗方案，恢复时间仍会延长。鉴于这些儿童以及扁桃体核心组织中发现的葡萄球菌高发病率，费城儿童医院开展了一项随机前瞻性研究，以评估头孢克洛与阿莫西林对扁桃体切除术后恢复患者的疗效。患者在手术时及术后12至24小时静脉注射氨苄西林或头孢唑林。当经口摄入量充足时，他们在术后额外7天口服阿莫西林或头孢克洛。获取术中口咽和扁桃体组织的培养物，以及术后7至14天扁桃体窝的培养物。对患者的术后症状严重程度和持续时间以及并发症进行评估。这项研究的结果显示两组患者之间没有差异。我们得出结论，扁桃体切除术后患者常规使用头孢克洛而非阿莫西林没有依据。
