Antimicrobial management of surgically treated gangrenous or perforated appendicitis: Comparison of cefoxitin and clindamycin-gentamicin

Patients with gangrenous or perforated appendicitis were treated with cefoxitin or a combination of clindamycin and gentamicin for a minimum of five post-operative days. Septic complications developed in four of the 54 patients receiving cefoxitin: one was an intra-abdominal abscess requiring surgery and three were wound infections. Of the 51 patients receiving clindamycin-gentamicin, two had septic complications: one was an intra-abdominal abscess requiring surgery and one was a wound abscess requiring drainage. The differences in the septic complications in the two treatment groups were not statistically significant. The cost to the patient of combined therapy with clindamycin and gentamicin was 36% higher than the cost of cefoxitin alone. The results demonstrate that cefoxitin alone is comparable to the 'gold standard' of clindamycin-gentamicin in the treatment of patients with gangrenous or perforated appendicitis.