Törnqvist A, Forsgren A, Leandoer L, Ursing J
Br J Surg. 1985 Apr;72(4):261-4. doi: 10.1002/bjs.1800720404.
In a prospective randomized open study of patients operated upon for diffuse peritonitis, the effects of two different antibiotic regimens were evaluated. Cefuroxime given as a single drug (Group I; n = 59) was compared with a combination of cefuroxime and metronidazole (Group II; n = 63). Bacteriological cultures, both aerobic and anaerobic, were obtained peroperatively and in the event of any complication. The antibiotic sensitivities of isolated bacteria, and the serum and tissue concentrations of cefuroxime were determined. Postoperative infectious complications occurred in 22 per cent of Group I patients (cefuroxime), and in 17.5 per cent of Group II (cefuroxime plus metronidazole). The mortality rates were 5 per cent for Group I and 8 per cent for Group II. Tissue concentrations of cefuroxime were well above the MIC (minimal inhibiting concentration) values for most of the bacteria isolated. From a few patients in Group I, however, cultures were obtained with isolates sensitive to metronidazole but resistant to cefuroxime. Our findings suggest that, in the antibiotic treatment of patients operated for diffuse peritonitis, an agent which is primarily effective against aerobic bacteria (but not entirely without effect on anaerobes) is as effective as combination therapy covering both aerobic and anaerobic bacteria.
在一项针对弥漫性腹膜炎手术患者的前瞻性随机开放研究中，评估了两种不同抗生素治疗方案的效果。将单药使用头孢呋辛的患者（第一组；n = 59）与使用头孢呋辛和甲硝唑联合治疗的患者（第二组；n = 63）进行比较。在手术过程中以及出现任何并发症时，采集需氧和厌氧细菌培养样本。测定分离出细菌的抗生素敏感性以及头孢呋辛的血清和组织浓度。第一组（头孢呋辛）患者术后感染并发症发生率为22%，第二组（头孢呋辛加甲硝唑）为17.5%。第一组死亡率为5%，第二组为8%。对于大多数分离出的细菌，头孢呋辛的组织浓度远高于最低抑菌浓度（MIC）值。然而，在第一组的少数患者中，培养出的分离菌株对甲硝唑敏感但对头孢呋辛耐药。我们的研究结果表明，在弥漫性腹膜炎手术患者的抗生素治疗中，一种主要对需氧菌有效的药物（但对厌氧菌并非完全无效）与覆盖需氧菌和厌氧菌的联合治疗同样有效。
