Meropenem versus tobramycin with clindamycin in the antibiotic management of patients with advanced appendicitis

J Am Coll Surg. 1996 May;182(5):403-7.

Abstract

Background: Meropenem (MP), a new carbapenem antibiotic, has excellent antimicrobial activity against the enteric flora commonly encountered in acute appendicitis. Although similar to imipenem, it may have clinical advantages.

Study design: We compared patients with advanced appendicitis (gangrenous or perforated) treated with 1,000 mg MP every eight hours with those given the combination of tobramycin 5 mg/kg/day at eight hour intervals and clindamycin 900 mg every eight hours. Both treatments were given intravenously. Patients were randomized to either group of the double-blind study.

Results: Of 129 evaluable cases, 63 received MP and 66 received both tobramycin and clindamycin (T/C). The two groups were similar in age, sex, and severity of disease. The mean number of days of postoperative fever (MP = 3.1 +/- 1.7 SD compared to T/C = 4.4 +/- 2.2 SD, p < or = 0.01), days of antibiotic therapy (MP = 6.1 +/- 1.6 SD compared to T/C = 7.3 +/- 2.2 SD, p = 0.01), and therefore hospital stay (MP = 8.0 +/- 3.5 SD compared to T/C = 9.4 +/- 2.6 SD, p < 0.01) were significantly better for patients treated with MP. No difference was found between the numbers of failures in each group (MP = 5 compared to T/C = 6).

Conclusions: This study demonstrates a small but significant reduction (approximately one day) in post-operative fever, duration of antibiotic treatment, and hospital stay for patients treated with MP compared to those treated with T/C.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Appendicitis / drug therapy*
  • Clindamycin / administration & dosage
  • Clindamycin / therapeutic use*
  • Double-Blind Method
  • Drug Administration Schedule
  • Drug Therapy, Combination / administration & dosage
  • Drug Therapy, Combination / therapeutic use
  • Female
  • Humans
  • Intestinal Perforation / drug therapy
  • Length of Stay
  • Male
  • Meropenem
  • Rupture, Spontaneous
  • Thienamycins / therapeutic use*
  • Time Factors
  • Tobramycin / administration & dosage
  • Tobramycin / therapeutic use*

Substances

  • Anti-Bacterial Agents
  • Thienamycins
  • Clindamycin
  • Meropenem
  • Tobramycin