Skip to main content
PMC home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1985 Nov;28(5):639–642. doi: 10.1128/aac.28.5.639

Randomized, prospective, and double-blind trial of new beta-lactams in the treatment of appendicitis.

W Y Lau, S T Fan, K W Chu, H C Suen, T F Yiu, K K Wong
PMCID: PMC176348  PMID: 3911877

Abstract

A prospective, randomized, and double-blind study was conducted with 864 patients operated on for appendicitis. In early cases, including normal and acute appendicitis, one dose of antibiotic was given. The rate of postappendectomy septic complications in patients who received cefotaxime, cefoperazone, or moxalactam was very low (about 3%), and there was no statistical difference between the drugs. For late cases, including gangrenous and perforated appendicitis, the antibiotics were continued for 5 days. Moxalactam decreased significantly the septic complications in these patients when compared with the other two drugs. It is safe, free from serious toxic side effects, and more convenient and easier to administer than combination antibiotic therapy. The main disadvantage of moxalactam is its high cost, but this has to be balanced against the savings in nursing time, the cost of monitoring renal function and serum level when aminoglycosides are used, and the reduced usage and manipulation of infusion sets.

Full text

PDF
641

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bauer A. W., Kirby W. M., Sherris J. C., Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966 Apr;45(4):493–496. [PubMed] [Google Scholar]
  2. Berne T. V., Yellin A. W., Appleman M. D., Heseltine P. N. Antibiotic management of surgically treated gangrenous or perforated appendicitis. Comparison of gentamicin and clindamycin versus cefamandole versus cefoperazone. Am J Surg. 1982 Jul;144(1):8–13. doi: 10.1016/0002-9610(82)90594-3. [DOI] [PubMed] [Google Scholar]
  3. Brumer M. Appendicitis. Seasonal incidence and postoperative wound infection. Br J Surg. 1970 Feb;57(2):93–99. doi: 10.1002/bjs.1800570204. [DOI] [PubMed] [Google Scholar]
  4. Burke J. F. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery. 1961 Jul;50:161–168. [PubMed] [Google Scholar]
  5. Busuttil R. W., Davidson R. K., Fine M., Tompkins R. K. Effect of prophylactic antibiotics in acute nonperforated appendicitis: a prospective, randomized, double-blind clinical study. Ann Surg. 1981 Oct;194(4):502–509. doi: 10.1097/00000658-198110000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Campbell W. B. Prophylaxis of infection after appendicectomy: a survey of current surgical practice. Br Med J. 1980 Dec 13;281(6255):1597–1600. doi: 10.1136/bmj.281.6255.1597. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Chiam H. L., Chee C. P., Cheah K. C., Somasundaram K., Puthucheary S. D. The prevention of postappendicectomy sepsis by metronidazole and cotrimoxazole: a controlled double blind trial. Aust N Z J Surg. 1983 Oct;53(5):421–425. doi: 10.1111/j.1445-2197.1983.tb02477.x. [DOI] [PubMed] [Google Scholar]
  8. Cunha B. A., Ristuccia A. M. Third generation cephalosporins. Med Clin North Am. 1982 Jan;66(1):283–291. doi: 10.1016/s0025-7125(16)31460-2. [DOI] [PubMed] [Google Scholar]
  9. Dipiro J. T., Bivins B. A., Record K. E., Bell R. M., Griffen W. O., Jr The prophylactic use of antimicrobials in surgery. Curr Probl Surg. 1983 Feb;20(2):69–132. doi: 10.1016/s0011-3840(83)80008-2. [DOI] [PubMed] [Google Scholar]
  10. Donovan I. A., Ellis D., Gatehouse D., Little G., Grimley R., Armistead S., Keighley M. R., Strachan C. J. One-dose antibiotic prophylaxis against wound infection after appendicectomy: a randomized trial of clindamycin, cefazolin sodium and a placebo. Br J Surg. 1979 Mar;66(3):193–196. doi: 10.1002/bjs.1800660317. [DOI] [PubMed] [Google Scholar]
  11. Fine M., Busuttil R. W. Acute appendicitis: efficacy of prophylactic preoperative antibiotics in the reduction of septic morbidity. Am J Surg. 1978 Feb;135(2):210–212. doi: 10.1016/0002-9610(78)90100-9. [DOI] [PubMed] [Google Scholar]
  12. Foster P. D., O'Toole R. D. Primary appendectomy. The effect of prophylatic cephaloridine on postoperative wound infection. JAMA. 1978 Apr 3;239(14):1411–1412. doi: 10.1001/jama.239.14.1411. [DOI] [PubMed] [Google Scholar]
  13. Giacomantonio M., Bortolussi R., Gillis D. A. Should prophylactic antibiotics be given perioperatively in acute appendicitis without perforation? Can J Surg. 1982 Sep;25(5):555–556. [PubMed] [Google Scholar]
  14. Gilmore O. J., Martin T. D. Aetiology and prevention of wound infection in appendicetomy. Br J Surg. 1974 Apr;61(4):281–287. doi: 10.1002/bjs.1800610407. [DOI] [PubMed] [Google Scholar]
  15. Ivarsson L. E. Single-dose antibiotic prophylaxis in appendectomy. Acta Chir Scand. 1977;143(7-8):469–472. [PubMed] [Google Scholar]
  16. LJUNGQVIST U. WOUND SEPSIS AFTER CLEAN OPERATIONS. Lancet. 1964 May 16;1(7342):1095–1097. doi: 10.1016/s0140-6736(64)91291-7. [DOI] [PubMed] [Google Scholar]
  17. Lau W. Y., Fan S. T., Yiu T. F., Poon G. P., Wong S. H. Prophylaxis of postappendicectomy sepsis by metronidazole and cefotaxime; a randomized, prospective and double blind trial. Br J Surg. 1983 Nov;70(11):670–672. doi: 10.1002/bjs.1800701110. [DOI] [PubMed] [Google Scholar]
  18. Lau W. Y., Fan S. T., Yiu T. F., Wong S. H. Prophylaxis of post-appendicectomy sepsis by metronidazole and ampicillin: a randomized, prospective and double-blind trial. Br J Surg. 1983 Mar;70(3):155–157. doi: 10.1002/bjs.1800700306. [DOI] [PubMed] [Google Scholar]
  19. Lau W. Y., Teoh-Chan C. H., Fan S. T., Yam W. C., Lau K. F., Wong S. H. The bacteriology and septic complication of patients with appendicitis. Ann Surg. 1984 Nov;200(5):576–581. doi: 10.1097/00000658-198411000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Lau W. Y., Wong S. H. Randomized, prospective trial of topical hydrogen peroxide in appendectomy wound infection. High risk factors. Am J Surg. 1981 Sep;142(3):393–397. doi: 10.1016/0002-9610(81)90358-5. [DOI] [PubMed] [Google Scholar]
  21. Leigh D. A., Pease R., Henderson H., Simmons K., Russ R. Prophylactic lincomycin in the prevention of wound infection following appendicectomy: a double blind study. Br J Surg. 1976 Dec;63(12):973–977. doi: 10.1002/bjs.1800631222. [DOI] [PubMed] [Google Scholar]
  22. Leigh D. A., Simmons K., Norman E. Bacterial flora of the appendix fossa in appendicitis and postoperative wound infection. J Clin Pathol. 1974 Dec;27(12):997–1000. doi: 10.1136/jcp.27.12.997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. MILES A. A., MILES E. M., BURKE J. The value and duration of defence reactions of the skin to the primary lodgement of bacteria. Br J Exp Pathol. 1957 Feb;38(1):79–96. [PMC free article] [PubMed] [Google Scholar]
  24. Magarey C. J., Chant A. D., Rickford C. R., Margarey J. R. Peritoneal drainage and systemic antibiotics after appendicectomy. A prospective trial. Lancet. 1971 Jul 24;2(7717):179–182. doi: 10.1016/s0140-6736(71)90894-4. [DOI] [PubMed] [Google Scholar]
  25. Morris W. T., Innes D. B., Richardson R. A., Lee A. J., Ellis-Pegler R. B. The prevention of post-appendicectomy sepsis by metronidazole and cefazolin: a controlled double blind trial. Aust N Z J Surg. 1980 Aug;50(4):429–433. doi: 10.1111/j.1445-2197.1980.tb04158.x. [DOI] [PubMed] [Google Scholar]
  26. Neu H. C. Good antimicrobial prescribing. Clinical uses of cephalosporins. Lancet. 1982 Jul 31;2(8292):252–255. doi: 10.1016/s0140-6736(82)90333-6. [DOI] [PubMed] [Google Scholar]
  27. Schentag J. J., Wels P. B., Reitberg D. P., Walczak P., Van Tyle J. H., Lascola R. J. A randomized clinical trial of moxalactam alone versus tobramycin plus clindamycin in abdominal sepsis. Ann Surg. 1983 Jul;198(1):35–41. doi: 10.1097/00000658-198307000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Weitekamp M. R., Aber R. C. Prolonged bleeding times and bleeding diathesis associated with moxalactam administration. JAMA. 1983 Jan 7;249(1):69–71. [PubMed] [Google Scholar]
  29. Winslow R. E., Dean R. E., Harley J. W. Acute nonperforating appendicitis. Efficacy of brief antibiotic prophylaxis. Arch Surg. 1983 May;118(5):651–655. doi: 10.1001/archsurg.1983.01390050117023. [DOI] [PubMed] [Google Scholar]
  30. Wittman D. H., Schassan H. H. Penetration of eight beta-lactam antibiotics into the peritoneal fluid. A pharmacokinetic investigation. Arch Surg. 1983 Feb;118(2):205–213. doi: 10.1001/archsurg.1983.01390020055010. [DOI] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES