Yellin A E, Berne T V, Heseltine P N, Appleman M D, Gill M, Chin A, Baker F J
Department of Surgery, University of Southern California, School of Medicine.
Am Surg. 1993 Apr;59(4):248-55.
Septic complications after surgery for enterogenous peritonitis are minimized by adjuvant antibiotics effective against aerobes and anaerobes. Historically, "gold standard" therapy included an aminoglycoside plus clindamycin, the latter given at 600 mg intravenous piggyback (IVPB), every 6 hours. Clindamycin pharmacokinetics suggests that it can be given q8h and admixed with gentamicin, thereby markedly reducing the cost of administration. Although this is now common practice, there is no prospective study comparing the efficacy of the two dose schedules in peritonitis. This study was designed to test the hypothesis regarding the clinical efficacy of the two regimens. One hundred twenty-six patients with gangrenous (n = 34) or perforated appendicitis (n = 91) were randomized (2:1) to receive gentamicin admixed with clindamycin 900 mg IVPB every 8 hours (Group I n = 80) or gentamicin IVPB q8h plus clindamycin 600 mg IVPB every 6 hours (Group II n = 46). Appendectomy was performed, and aerobic and anaerobic cultures were obtained. Twenty-one patients had simultaneous determinations of clindamycin levels in plasma, peritoneal fluid, and appendix. Outcome analysis revealed no significant differences in postoperative days of fever, days non per os, antibiotic therapy, or hospitalization. There were 6 failures (4 abscesses and 2 wound infections) in Group I and 4 failures (1 abscess and 3 wound infections) in Group II. Both antibiotic regimens provided clinically equivalent results in mixed infections due to aerobic and anaerobic bacteria. The admixed clindamycin, administered every 8 hours, results in at least 20% reduction in costs. This is an important consideration.
通过使用对需氧菌和厌氧菌有效的辅助性抗生素，可将肠源性腹膜炎手术后的感染性并发症降至最低。从历史上看，“金标准”疗法包括一种氨基糖苷类药物加克林霉素，后者以600毫克静脉滴注（IVPB）的方式，每6小时给药一次。克林霉素的药代动力学表明，它可以每8小时给药一次，并与庆大霉素混合使用，从而显著降低给药成本。尽管这现在已是常见做法，但尚无前瞻性研究比较这两种给药方案在腹膜炎中的疗效。本研究旨在检验关于这两种治疗方案临床疗效的假设。126例坏疽性阑尾炎（n = 34）或穿孔性阑尾炎（n = 91）患者被随机分组（2:1），分别接受每8小时静脉滴注一次与庆大霉素混合的900毫克克林霉素（第一组，n = 80），或每8小时静脉滴注一次庆大霉素加每6小时静脉滴注一次600毫克克林霉素（第二组，n = 46）。进行了阑尾切除术，并获取了需氧和厌氧培养物。21例患者同时测定了血浆、腹腔液和阑尾中的克林霉素水平。结果分析显示，两组在术后发热天数、禁食天数、抗生素治疗或住院时间方面无显著差异。第一组有6例治疗失败（4例脓肿和2例伤口感染），第二组有4例治疗失败（1例脓肿和3例伤口感染）。两种抗生素治疗方案在需氧菌和厌氧菌混合感染中提供了临床等效的结果。每8小时给药一次的混合克林霉素可使成本至少降低20%。这是一个重要的考虑因素。
