Streptomycin and the Tetracyclines in Acute Appendicitis

THE use of penicillin and sulphonamide, intravenous fluid replacement and gastric suction greatly reduced the mortality and complication rates of acute appendicitis. For the past few years streptomycin, aureomycin, and terramycin have been available, and the purpose of this investigation was to determine whether or not their use had resulted in any further improvement in the mortality and complication rates. MATERIAL. I have traced 266 appendicectomies for acute appendicitis, performed by me in several hospitals in Northern Ireland, during the period November, 1947, to March, 1954. The degree of intensity of the inflammatory change present was judged by the naked eye, and recorded as the following stages:(1) Mild; (2) Acute; (3) Gangrenous; (4) Perforated; (5) Acute, gangrenous or perforated stages with pus locally; (6) Acute, gangrenous or perforated stages with general peritonitis. As cases where, at operation, the inflammation is found to have spread beyond the appendix are most likely to be influenced by chemotherapy, only cases of stages 4, 5, and 6 have been included in this investigation. There were 58 in all, and of these 26 were treated with penicillin and sulphonamide, and 32 with either penicillin and streptomycin, aureomycin or terramycin. The usual daily dose of penicillin was 400,000 units, sulphonamide 6 grammes, streptomycin 1-2 grammes, aureomycin 2 grammes, and terramycin 2 grammes.