Efficacy of Amikacin and Ceftriaxone in the empiric antibacterial therapy of friable appendicular infiltrate and periappendicular abscess at different age groups

Abstract

Introduction. In the structure of acute pathology in the abdominal cavity of children associated with appendicular peritonitis, local limited forms occur in 10–16.8% of cases, mainly in older patients.Purpose. To make a comparative assessment of Amikacin and Ceftriaxone efficacy in the empiric antibacterial therapy of appendicular infiltrate and periappendicular abscess in children of different age groups under the dynamics of inflammatory process and results of bacteriological tests.Material and methods. The article provides a retrospective analysis of 43 medical records of children of various ages with appendicular infiltrate and periappendicular abscess. All patients had a quantitative assessment of inflammatory markers and bacteriological findings in their gastric content. Amikacin and Ceftriaxone were prescribed as a starting antibacterial therapy.Results. The present trail revealed a rather high incidence of appendicular infiltrate and periappendicular abscess in children. The maximum increase in leukocytes number, C-reactive protein were registered before surgery and one day after it, mostly in little children. The acid α1-glycoprotein level was increasing during the first day after surgery in little patients, while in adolescents and teenagers it didn’t change significantly.Bacteriological examination of the gastric content revealed that the most common pathogens were Escherichia coli (34.9%) and Pseudomonas aeruginosa (14%). Many pathogenic bacteria were highly sensitive to Amikacin and little sensitive to Ceftriaxone. In two children, lack of sensitivity of microorganisms to antibacterial drugs caused the development of abdominal abscesses in the postoperative period.Conclusion. The empiric antibiotic therapy is of great importance in the management of appendicular infiltrate and periappendicular abscess. While prescribing the starting antibiotic therapy, a physician has to use his/her experience and to know or to anticipate possible microflora nature and its sensitivity to antimicrobial preparations.