RCB: A randomized comparative study of sulbactam plus ampicillin vs. metronidazole plus cefotaxime in the management of acute appendicitis

Sulbactam is a 13-lactamase inhibitor that, when combined with ampicillin, gives the lat-ter antibiotic a broad spectrum of activity, making it suitable for use as a prophylactic agent in acute appendicitis. In a single-blind, randomized trial, the efficacy of sulbactam plus ampicillin was compared with that of metronidazole plus cefotaxime. Thirty-five children undergoing appendectomy received intravenous sulbactam and ampicillin, while 38 children received metronidazole and cefotaxime. Single doses were given unless the appendix was considered gangrenous or perforated, in which case the drugs were ad-ministered for 72 hr. There were three wound infections in the group given sulbactam and ampicillin and five in the group given metronidazole and cefotaxime. The combina-tion of sulbactam and ampicillin was well tolerated and appeared to be at least as effec-tive as that of metronidazole and cefotaxime in the prevention of sepsis following appen-dectomy. It is wellestablished that the use of prophylactic an-tibiotics lowers the incidence of wound infection in patients undergoing appendectomy [1-3]. Com