מתוך medicontext.co.il
By Megan Rauscher
WESTPORT, (Reuters Health) – Results of a pilot study indicate that a short course of intravenous antibiotics followed by oral antibiotics is as effective as a prolonged course of IV antibiotics in children with perforated appendicitis found at laparotomy.
A multicenter team of US investigators led by Dr. Henry E. Rice of Duke University in Durham, North Carolina, report the finding in the Archives of Surgery for December 2001.
Following appendectomy, Dr. Rice's team randomized 10 children to a 10-day course of IV triple antibiotic therapy consisting of ampicillin, gentamicin sulfate and clindamycin, "which is an accepted treatment in many institutions," Dr. Rice said in a telephone interview with Reuters Health.
Another 16 children were randomized to IV triple antibiotic therapy with the same drugs followed by conversion to oral antibiotic therapy when gastrointestinal function returned, usually within 3-5 days. Oral antibiotics consisted of amoxicillin/clavulanate potassium plus metronidazole.
The outcomes for both groups were essentially equivalent. "At least in this small study, children who were treated with oral antibiotics as soon as they could be, did just as well as children who received a prolonged course of IV antibiotics," Dr. Rice said.
The early use of oral antibiotics led to significant cost savings, roughly $1500 per patient, without any increase in complications.
This sequential IV/oral antibiotic protocol has become "standard at our institution and it probably will become at least one accepted option at other institutions," Dr. Rice predicted. He and his colleagues are designing a large national or perhaps international prospective study to confirm their findings.
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