Perforated Appendicitis in Children: Use of Metronidazole for the Reduction of Septic Complications

Puri, P; Rangecroft, L.; Zervos, G.; Ej, Guiney; O’Donnell, Brett A

doi:10.1055/s-2008-1063245

Cited by 6 publications

(8 citation statements)

References 6 publications

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“…Although it is commonly held that obstruction of the appendiceal lumen and subsequent tissue hypoxia and bacterial overgrowth are the precipitating factors of this disease,3,4 there is scant evidence to support or refute this hypothesis. Although obstruction of the intestinal lumen by a fecalith is a common finding in AA, large studies suggest that a fecalith is not present in as many as 50 % of cases 5.…”

Section: Introductionmentioning

confidence: 99%

Acute appendicitis is characterized by a uniform and highly selective pattern of inflammatory gene expression

et al. 2008

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Acute appendicitis (AA) is the most common life-threatening surgical emergency in pediatrics. To characterize the nature of the inflammatory response in AA, gene expression profiles were generated. We found remarkable uniformity in the genes that were differentially expressed between patients with appendicitis and control groups. Sixty-four probe sets were differentially expressed in samples from patients with both severe and mild appendicitis compared to control samples, and within this group we were able to identify four dominant clusters. Interestingly, expression levels of interleukin (IL)-8 significantly correlated with histologic score, and expression of IL-8 protein was observed within both neutrophils and mononuclear cells by immunohistochemistry, suggesting a possible role in the etiology of appendicitis. Although there was some overlap between genes reported to be differentially expressed in Crohn's disease (CD) and those observed in AA, differential expression of genes involved in interferon responses that characterize CD was not observed.

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Section: Introductionmentioning

confidence: 99%

Acute appendicitis is characterized by a uniform and highly selective pattern of inflammatory gene expression

et al. 2008

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“…In comparable series reported during the last 10 years the rate of complications has ranged from 10 % to 480/0 (1,5,8,14,16,17,22) or has been nil (7). Our high rate of complications, 320/0, may partly be explained by de- laycd administration of antibioties.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, already more than 80 years ago the pathogenetic interaction between anaerobes and aerobs had been c1early implicated in appendicular peritonitis (3,15,21). In recent years interest in the role of anaerobes in the complications on intestinal surgery has been reneved and swdied both clinically and experimentally (4,7,10,11,12,13,14,18). Because there is still some comroversy over which antimicrobials are most effective in the treatment of appendicular peritonitis ( compared the efficacy of the combination tobramycin-clindamycin with that of cephalothin followed by cephalexin in a prospective study.…”

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confidence: 99%

Tobramycin-clindamycin Versus Cephalothin-cephalexin in the Treatment of Appendicular Peritonitis

L¹,

Nuutinen²,

J³

et al. 1981

Eur J Pediatr Surg

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Forty-seven children, ages 1 to 14 years, with appendicular peritonitis were randomly divided into two groups: 27 were treated with the combination tobramycin-clindamycin and 20 with cephalothin followed by cephalexin. The overall rate of complications was 32%. Patients who had had their symptoms for less than 48 hours before being admitted to hospital had significantly fewer complications than those whose symptoms had lasted longer. Patients treated with tobramycin-clindamycin had significantly fewer wound infections. As clindamycin is effective against anaerobes this observation supports the view that anaerobes play an important role in the infectious complications in peritonitis. In this series, 12 species of aerobes and eight species of anaerobes were cultured from peritoneal fluid. In eight patients only one species was isolated; in the remaining 39 patients 29 different combinations of bacteria were encountered. Early diagnosis and administration of antibiotics preoperatively or during surgery, including clindamycin, metronidazol or tinidazol is recommended in the treatment of children with appendicular peritonitis.

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“…Die Effektivität von Metronidazol bei anaeroben Infektionen ist nicht nur durch unsere Studie, sondern auch durch zahlreiche andere Publikationen belegt (7,8,19). Die Vorteile liegen vor allem darin, daß sowohl durch die intravenöse als auch durch die rektale Verabreichung ausreichende Gewebsspiegel erreicht werden können (8).…”

Section: Patientengut Und Methodeunclassified

“…Den Fortschritten der Intensivmedizin und dem Einsatz geeigneter Antibiotika ist es zu verdanken, daß heute nahezu kein Kind mehr an einer Appendicitis perforata stirbt. Postoperative Komplikationen, insbesondere durch Wundabszesse, intraperitoneale Abszesse sind dagegen häufig, und die Morbidität nach Perforation einer Appendizitis wurde in der Literatur mit Raten zwischen 30% und 80% angegeben (4,7,13,19,20,22). Trotz der Anwendung verschiedener lokaler Maßnahmen wie Bauchhöhlenspülungen oder Drainagen schien gerade die Rate postoperativer Wundinfektionen und intraabdomineller Abszesse unbeeinflußbar zu bleiben, so daß einige Autoren eine grundsätzlich offene Wundbehandlung mit sekundärer Faszienhautnaht oder bei Fehlen von klinischen Sepsiszeichen sogar den völligen Verzicht auf eine antibiotische Behandlung empfahlen (1,9,12,21).…”

Section: Zusammenfassungunclassified

Die antibiotische Behandlung der Appendicitis perforata im Kindesalter - Eine prospektive Studie

Höllwarth¹,

Graf²,

Kurz³

et al. 1986

Eur J Pediatr Surg

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A prospective randomised study (I) was carried out on 130 children undergoing laparotomy for perforated appendicitis. The present study evaluates the therapeutic effectiveness of different antibiotic regimens in modifying the rate of post-operative complications (intraabdominal abscess, ileus, wound infiltration or abscess). During the first year of this study two treatment groups were used. Group A consisted of 29 children treated with Sulfometrol/Trimethoprim; the rate of postoperative complications was 44.8%. Group B consisted of 36 children treated with mezlocillin, the rate of complications being 13.8%. However, the same treatment with mezlocillin during the second year of the prospective study showed an increase of this rte to 39% (28 children--group C). The final group of 37 children was treated during the second year with mezlocillin and metronidazole (group D). The postoperative rate of complications was 10.8%. A retrospective analysis of further 80 children (study II) with perforated appendicitis treated with mezlocillin and metronidazole showed a consistent low rate of postoperative complications at 10.2%. In 6.8% of children studied, an operative intervention was necessary (four cases of ileus, four wound abscesses). The mean postoperative hospitalisation period decreased from 22.7 days in group A to 15.2 days in group D and finally to 14 days in study II. The present study shows that an effective and persistent attenuation of the rate of postoperative complications after perforated appendicitis in children depends on an early onset of therapy and on the appropriate choice of antibiotic drugs that are effective against aerobic and anaerobic microorganisms.

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Perforated Appendicitis in Children: Use of Metronidazole for the Reduction of Septic Complications

Cited by 6 publications

References 6 publications

Acute appendicitis is characterized by a uniform and highly selective pattern of inflammatory gene expression

Acute appendicitis is characterized by a uniform and highly selective pattern of inflammatory gene expression

Tobramycin-clindamycin Versus Cephalothin-cephalexin in the Treatment of Appendicular Peritonitis

Die antibiotische Behandlung der Appendicitis perforata im Kindesalter - Eine prospektive Studie

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