Gangrenous appendicitis in children: a different approach.

Fifty children with gangrenous appendicitis were treated consecutively by appendectomy followed by saline irrigation and loose wound closure. Drainage was not employed. Ampicillin and oxacillin were mixed and given intravenously. In 28 of 50 patients, ampicillin powder was dusted into the wound. No intraperitoneal complications occurred. Seven would infections required incision. Dusting ampicillin powder into the wound reduced this complication to less than 10 per cent. Four patients had nasogastric tubes. The usual hospital stay was three to eight days. The most common organisms cultured were Escherichia coli (68%), Streptococcus species (60%), and anaerobic species (48%). Eleven patients were evaluated for synergism between ampicillin and oxacillin. Eight showed some evidence of synergism in that the minimal inhibitory concentration (MIC) of the combination was less than the MIC of the individual drugs.