Open-Label Prospective Randomized Comparative Study of the Efficacy and Safety of Gentamicin in Comparison to Other Antibiotics in the Management of Acute Appendicitis in Surgically Treated Patients

Background: Antimicrobial resistance coupled with the lack of new antibiotics calls for the responsible use of antibiotics, including old antimicrobials. Aminoglycosides are effective against bacteria in acute appendicitis, a common intra-abdominal infection. Their use has been discouraged recently, but their place in therapy is based on studies performed in the era of lower resistance rates, and with multiple dosing regimens. Methods: In a prospective randomized open-label study, we compared the efficacy and safety of gentamicin in one daily dose and metronidazole (GTM+MZ) to ertapenem (ETP) and to cefuroxime with metronidazole (CXM+MZ) in adult patients surgically treated for acute appendicitis. Efficacy was assessed via the duration of antibiotic treatment and hospital stay, c-reactive protein (CRP) dynamics, and post-operative complications. Nephrotoxicity was assessed with urine biomarkers. Statistical analysis comprised mixed-model analysis of variance (ANOVA) with the missing-data-imputation method and linear mixed model (LMM). Results: One hundred-and-sixty-six patients were included in this study. There were no significant differences among the three groups in the durations of treatment and lengths of stay (p = 0.093, p = 0.222). CRP level was the lowest (p = 0.003) in the ETP group. There were five complications during hospitalization, with two of them classified as infectious. Both occurred in the GTM+MZ group; however, the difference was not statistically significant (p = 0.330). No difference was found in complications in the month following the operation (p = 0.763). Biomarkers indicating kidney injury showed the same trend in all three groups. Conclusions: Our results suggest the use of once-daily dose of gentamicin following an appendectomy for acute appendicitis. Gentamicin may be used to decrease selective pressure of other antimicrobials.