Malangoni M A, Condon R E, Spiegel C A
Surgery. 1985 Oct;98(4):648-55.
In a prospective, randomized, single-blind trial, we studied 112 adults with intra-abdominal infections and compared antibiotic therapy with cefoxitin plus placebo to therapy with tobramycin plus clindamycin. Seventy-five percent of patients receiving tobramycin-clindamycin and 71% of those receiving cefoxitin-placebo had either shock, bacteremia, malnutrition, alcoholism, rapidly or ultimately fatal underlying disease, infection originating from the distal small bowel or colon, or had had failed therapy before treatment ("high-risk" group). One third of the patients in both groups grew bacteria in the initial culture resistant to the antibiotic regimen used. Ten patients receiving cefoxitin-placebo (17%) and 11 receiving tobramycin-clindamycin (21%) had recurrence of infection or died of infection (clinical failures). Nineteen failures occurred in high-risk patients (p less than 0.05) and 17 were in patients that had antibiotic-resistant bacteria in the initial culture (p less than 0.01). Adverse effects were rare and remitted after antibiotics were stopped. Our results suggest that both cefoxitin and tobramycin-clindamycin are appropriate antibiotic regimens to treat intra-abdominal infections. Clinical failure is more common in high-risk patients and when antibiotic-resistant organisms are isolated from initial cultures.
在一项前瞻性、随机、单盲试验中，我们研究了112例患有腹腔内感染的成年人，并将头孢西丁加安慰剂的抗生素治疗与妥布霉素加克林霉素的治疗进行了比较。接受妥布霉素 - 克林霉素治疗的患者中有75%以及接受头孢西丁 - 安慰剂治疗的患者中有71%患有休克、菌血症、营养不良、酗酒、患有迅速或最终致命的基础疾病、感染源自远端小肠或结肠，或在治疗前治疗失败（“高危”组）。两组中均有三分之一的患者在初始培养中培养出对所用抗生素方案耐药的细菌。接受头孢西丁 - 安慰剂治疗的10例患者（17%）和接受妥布霉素 - 克林霉素治疗的11例患者（21%）出现感染复发或死于感染（临床失败）。19例失败发生在高危患者中（p<0.05），17例发生在初始培养中有抗生素耐药菌的患者中（p<0.01）。不良反应很少见，停用抗生素后缓解。我们的结果表明，头孢西丁和妥布霉素 - 克林霉素都是治疗腹腔内感染的合适抗生素方案。临床失败在高危患者中以及从初始培养中分离出抗生素耐药菌时更为常见。
