human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Intraperitoneal culturing during appendectomy is a routine procedure . Significant decrease in the mortality and dramatic improvement in the morbidity were achieved by using antibiotics perioperatively . The value of intraoperative abdominal cavity culture was assessed in our study . METHODS A total of 499 patients formed two groups , those with acute nonperforated appendicitis ( group A ) and those with perforated appendicitis ( group B ) . Intraoperative abdominal cavity culture were taken r and omly in both groups . The perioperative morbidity , the validity , and the impact of positive culture on the antibiotic treatment were examined in both groups . RESULTS Clinical diagnosed perforation was confirmed histologically in 176 patients ( 98.3 % accuracy ) . Intraperitoneal cultures were obtained in 30.1 % of the patients in group A and in 67.1 % of group B. The majority of the patients in group A were treated preoperatively and postoperatively by a single antibiotic agent whereas 58.0 % of the patients in group B were started on triple-agent antibiotics for significantly longer periods ( 22.4 + /- 9.4 versus 5.7 + /- 7.4 doses , respectively ; P < 0.0001 ) . No significant difference was found in both groups in the postoperative complication rate ( wound infection , intra-abdominal abscess and small bowel obstruction ) whether intra-abdominal culture was obtained or not ( 5.9 % versus 4.7 % in group A and 21.2 % versus 21.9 % in group B ; P > 0.05 ) . CONCLUSION Traditional intraoperative abdominal cavity culture can be ab and oned . In perforated appendicitis , colonic flora can be predicted , and antibiotic therapy should begun without any abdominal cavity culture results . This practical approach will save money and reduce laboratory work without affecting the patient 's morbidity Sulbactam is a beta-lactamase inhibitor , which when administered with ampicillin , increases the latter agents antibacterial activity against beta-lactamase producing organisms . One hundred children between the ages of 5 and 14 undergoing emergency appendectomy were entered into a prospect i ve r and omized trial comparing sulbactam and ampicillin ( SA ) with metronidazole and cefotaxime ( MC ) as prophylaxis against postoperative wound infection .  Patients in whom the appendix was perforated or gangrenous received a 72-hour course of antibiotics , others received a single dose only . The overall wound infection rate was 8 % ( 14 % in patients with perforation or gangrene and 4 % in those without ) . There was no difference in infection rate between the two antibiotic groups ; there were three wound infections and one subphrenic abscess in patients receiving SA and four wound infections in patients receiving MC . SA , therefore , appears to be a suitable antibiotic combination for use as prophylaxis in appendicitis in children A prospect i ve r and omised study ( I ) was carried out on 130 children undergoing laparotomy for perforated appendicitis . The present study evaluates the therapeutic effectiveness of different antibiotic regimens in modifying the rate of post-operative complications ( intraabdominal abscess , ileus , wound infiltration or abscess ) . During the first year of this study two treatment groups were used . Group A consisted of 29 children treated with Sulfometrol/Trimethoprim ; the rate of postoperative complications was 44.8 % . Group B consisted of 36 children treated with mezlocillin , the rate of complications being 13.8 % . However , the same treatment with mezlocillin during the second year of the prospect i ve study showed an increase of this rte to 39 % ( 28 children -- group C ) . The final group of 37 children was treated during the second year with mezlocillin and metronidazole ( group D ) . The postoperative rate of complications was 10.8 % . A retrospective analysis of further 80 children ( study II ) with perforated appendicitis treated with mezlocillin and metronidazole  showed a consistent low rate of postoperative complications at 10.2 % . In 6.8 % of children studied , an operative intervention was necessary ( four cases of ileus , four wound abscesses ) . The mean postoperative hospitalisation period decreased from 22.7 days in group A to 15.2 days in group D and finally to 14 days in study II . The present study shows that an effective and persistent attenuation of the rate of postoperative complications after perforated appendicitis in children depends on an early onset of therapy and on the appropriate choice of antibiotic drugs that are effective against aerobic and anaerobic microorganisms A prospect i ve , r and omized , double-blind clinical trial was undertaken comparing gentamicin , ampicillin , and clindamycin ( GAC ) to gentamicin , ampicillin , and placebo ( GAP ) in children with complicated appendicitis . Of the 64 patients enrolled in this study , 33 were assigned to the GAC group and 31 received GAP . A single GAC patient ( 3 % ) was considered a therapeutic failure in comparison to seven children ( 23 % ) in the GAP group ( P less than 0.05 ) . Duration of fever was significantly prolonged in the GAP patients ( 4.7 + /- .8 days versus 2.9 + /- .5 days ) when compared to the clindamycin treated children ( P less than 0.05 ) . Duration of leukocytosis was 3.2 + /- .4 days for GAC patients and 4.9 + /- .9 days for those on the GAP protocol ( P = 0.08 ) . On the basis of this experience the routine use of gentamicin , ampicillin , and clindamycin is recommended for all children with complicated appendicitis A prospect i ve study was conducted on 344 children aged from 3 months to 16 years with acute appendicitis . Most children presented with typical features of acute appendicitis ( 70 % ) or peritonitis ( 28 % ) . Atypical presentation was uncommon and occurred only in seven young children , masquerading as intestinal obstruction , gastroenteritis or urinary tract infection . Prolonged delay in surgery was associated with a rise in incidence of late appendicitis ( gangrenous and perforated appendicitis ) . This rise was especially marked 37 h after onset of symptoms . The main causes of delay were inability of the parents and primary care medical practitioners to recognize the disease early . Surgeons contributed very little to the delay . High risk factors for postappendectomy sepsis were young children under 6 years old , late appendicitis , obese patients , inferior systemic antibiotic regimes and inexperienced surgeons . Young children had high postoperative sepsis mainly because of the high incidence of late appendicitis due to their inability to express their symptoms properly . They were not especially prone to postappendectomy sepsis ; they had the same degree of appendicitis compared with older children . Measures to decrease the postappendectomy morbidity are suggested 60 consecutive children operated for perforated appendicitis were treated r and omly with either penicillin and streptomycin or with clindamycin and gentamycin .  Suppurative complications occurred somewhat more often and were definitely more severe in the former group . The number of hospital days spent in the treatment of these complications were three times as great in the former than in the latter group . Bacteroides fragilis could be isolated in most of the severe infections treated without clindamycin . Two out of 28 patients treated with clindamycin presented with severe diarrhoea BACKGROUND / PURPOSE Controversy persists in the management of perforated appendicitis with regard to antibiotic choice and duration , operative timing , drain utilization , and wound closure . For 2 decades at the authors ' institution , patients were treated with ampicillin , gentamicin , and clindamycin for 10 inpatient days , with drains in the abdomen , result ing in lower complication rates than most other published series . Managed care pressures have led to less aggressive medical management regimens with length of stay and financial factors viewed as principal outcome measures with little emphasis on clinical outcomes . In addition , there are little prospect i ve data on clinical outcomes . The authors sought to determine whether our previously documented excellent quality outcomes could be maintained when modifications aim ed at decreasing cost and length of stay in our protocol were instituted . METHODS The authors monitored prospect ively clinical outcomes in patients with perforated appendicitis treated according to their clinical practice guidelines over a 43-month period . Patients received a single antibiotic , piperacillin-tazobactam , intravenously for 10 days . They were permitted to go home with a percutaneous intravenous catheter for the final 5 days if medical and social criteria were met . Other practice s from our earlier protocol were continued , including immediate operation , placement of Penrose drains , and primary wound closure . RESULTS Of 150 patients treated on our protocol , major complications included intraabdominal abscess in 5 ( 3.3 % ) , cecal fistula in 2 ( 1.3 % ) , phlegmon in 3 ( 2.0 % ) , wound infection in 4 ( 2.7 % ) , and no small bowel obstructions requiring operation . None of these complications , nor their aggregate , were significantly more common than those reported in 373 patients treated over 11 years on the authors ' prior protocol ( chi2 , P > .05 ) . CONCLUSIONS Prospect i ve outcome analysis of our protocol shows that a single broad-spectrum antibiotic ( allowing portions of therapy to be delivered less expensively on an outpatient basis ) effectively can treat postoperative appendicitis with very few infectious complications . These outcome data provide baseline against which future protocol s can be compared . All treatment modifications aim ed at decreasing costs must be analyzed to ensure quality of care is not unduly compromised In a multicentre trial we compared the clinical efficacy of amoxicillin/clavulanate used as a single-agent therapy with that of the three-agent combination usually prescribed in the post-operative period for appendicular peritonitis in children . Only bacteriologically documented peritoneal infections were included . Sixty-four patients were r and omly distributed between two groups : Group A ( 29 cases ) treated with amoxicillin/clavulanate , first administered iv ( 100 mg/kg/d ) , followed by conversion to the oral route ( 50 mg/kg/d ) once the patient had been afebrile for 48 hours ; Group B ( 35 cases ) first treated by the iv route with benzylpenicillin ( 100,000 IU/kg/d ) plus netilmicin ( 5 mg/kg/d ) plus metronidazole ( 30 mg/kg/d ) , followed by conversion to the oral route for metronidazole ( 30 mg/kg/d ) . In both groups , the total duration of parenteral and oral treatment was not less than 5 days . One hundred and seventy nine bacterial strains were recovered from peritoneal fluid sample s obtained during surgery ; 86 % of these were sensitive to amoxicillin/clavulanate .  Clinical efficacy , assessed on the basis of time until return to normal temperature and gut transit and duration of hospitalization , was identical in both groups , with follow-up monitoring on day 30 showing recovery in all cases . Cure was obtained without any problems of infection in 25/29 patients in group A and in 34/35 patients in group B ( non significant difference ) . Tolerance was excellent and identical in the two groups with the exception of three cases of thrombophlebitis which occurred in group B. The results of this study suggest that amoxicillin/clavulanate may be useful as single-agent therapy as a first-line curative treatment for appendicular peritonitis in children Optimal management of children with perforated appendicitis remains a controversial clinical problem . Until very recently , the criteria for hospital discharge on our surgical service included the absence of fever and leukocytosis for a period of 48 hours following completion of antimicrobial therapy , uncomplicated wound healing , a normal rectal examination , and unimpaired gastrointestinal function . With the introduction of cost-containment programs , the necessity for the period of inpatient observation following cessation of antibiotics was question ed . The records of 87 consecutive children with perforated appendicitis were analyzed prospect ively in order to determine if our discharge policies were medically sound and cost-effective . Seventy-five patients ( 86 % ) recovered uneventfully while 12 children required prolonged hospitalization for management of various postoperative complications . The 12 patients who developed complications were all identifiable early in the postoperative period because of persistent fever , leukocytosis , and elevated b and counts . Of the 75 children who recovered uneventfully , all met st and ard discharge criteria on the final day of antibiotic therapy with the exception of completing the m and atory 48-hour period of inpatient observation . These children were maintained in the hospital a total of 142 additional days following discontinuation of antibiotics . The average cost per patient day for children with perforated appendicitis during the study period was $ 506.32 , which represented unnecessary hospital charges of $ 71,897.44 . It was concluded that inpatient observation following cessation of antibiotic therapy in children who experience an uneventful recovery from perforated appendicitis is neither necessary nor cost-effective . ( ABSTRACT TRUNCATED AT 250 WORDS Although single antimicrobials with broad-spectrum aerobic and anaerobic coverage are effective in patients with appendicitis , many 
    Output:
    
agent
There was no consistency among the protocol s regarding length of antibiotic use , discharge criteria , or use of home antibiotics following discharge .
Limiting duration of antibiotic use to3 days did not appear to be associated with higher rates of intraabdominal abscess or wound infection .
In the absence of higher-level evidence , shortening of antibiotic regimens following surgery for pediatric complicated appendicitis appears to be safe
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Intraperitoneal culturing during appendectomy is a routine procedure . Significant decrease in the mortality and dramatic improvement in the morbidity were achieved by using antibiotics perioperatively . The value of intraoperative abdominal cavity culture was assessed in our study . METHODS A total of 499 patients formed two groups , those with acute nonperforated appendicitis ( group A ) and those with perforated appendicitis ( group B ) . Intraoperative abdominal cavity culture were taken r and omly in both groups . The perioperative morbidity , the validity , and the impact of positive culture on the antibiotic treatment were examined in both groups . RESULTS Clinical diagnosed perforation was confirmed histologically in 176 patients ( 98.3 % accuracy ) . Intraperitoneal cultures were obtained in 30.1 % of the patients in group A and in 67.1 % of group B. The majority of the patients in group A were treated preoperatively and postoperatively by a single antibiotic agent whereas 58.0 % of the patients in group B were started on triple-agent antibiotics for significantly longer periods ( 22.4 + /- 9.4 versus 5.7 + /- 7.4 doses , respectively ; P < 0.0001 ) . No significant difference was found in both groups in the postoperative complication rate ( wound infection , intra-abdominal abscess and small bowel obstruction ) whether intra-abdominal culture was obtained or not ( 5.9 % versus 4.7 % in group A and 21.2 % versus 21.9 % in group B ; P > 0.05 ) . CONCLUSION Traditional intraoperative abdominal cavity culture can be ab and oned . In perforated appendicitis , colonic flora can be predicted , and antibiotic therapy should begun without any abdominal cavity culture results . This practical approach will save money and reduce laboratory work without affecting the patient 's morbidity Sulbactam is a beta-lactamase inhibitor , which when administered with ampicillin , increases the latter agents antibacterial activity against beta-lactamase producing organisms . One hundred children between the ages of 5 and 14 undergoing emergency appendectomy were entered into a prospect i ve r and omized trial comparing sulbactam and ampicillin ( SA ) with metronidazole and cefotaxime ( MC ) as prophylaxis against postoperative wound infection .  Patients in whom the appendix was perforated or gangrenous received a 72-hour course of antibiotics , others received a single dose only . The overall wound infection rate was 8 % ( 14 % in patients with perforation or gangrene and 4 % in those without ) . There was no difference in infection rate between the two antibiotic groups ; there were three wound infections and one subphrenic abscess in patients receiving SA and four wound infections in patients receiving MC . SA , therefore , appears to be a suitable antibiotic combination for use as prophylaxis in appendicitis in children A prospect i ve r and omised study ( I ) was carried out on 130 children undergoing laparotomy for perforated appendicitis . The present study evaluates the therapeutic effectiveness of different antibiotic regimens in modifying the rate of post-operative complications ( intraabdominal abscess , ileus , wound infiltration or abscess ) . During the first year of this study two treatment groups were used . Group A consisted of 29 children treated with Sulfometrol/Trimethoprim ; the rate of postoperative complications was 44.8 % . Group B consisted of 36 children treated with mezlocillin , the rate of complications being 13.8 % . However , the same treatment with mezlocillin during the second year of the prospect i ve study showed an increase of this rte to 39 % ( 28 children -- group C ) . The final group of 37 children was treated during the second year with mezlocillin and metronidazole ( group D ) . The postoperative rate of complications was 10.8 % . A retrospective analysis of further 80 children ( study II ) with perforated appendicitis treated with mezlocillin and metronidazole  showed a consistent low rate of postoperative complications at 10.2 % . In 6.8 % of children studied , an operative intervention was necessary ( four cases of ileus , four wound abscesses ) . The mean postoperative hospitalisation period decreased from 22.7 days in group A to 15.2 days in group D and finally to 14 days in study II . The present study shows that an effective and persistent attenuation of the rate of postoperative complications after perforated appendicitis in children depends on an early onset of therapy and on the appropriate choice of antibiotic drugs that are effective against aerobic and anaerobic microorganisms A prospect i ve , r and omized , double-blind clinical trial was undertaken comparing gentamicin , ampicillin , and clindamycin ( GAC ) to gentamicin , ampicillin , and placebo ( GAP ) in children with complicated appendicitis . Of the 64 patients enrolled in this study , 33 were assigned to the GAC group and 31 received GAP . A single GAC patient ( 3 % ) was considered a therapeutic failure in comparison to seven children ( 23 % ) in the GAP group ( P less than 0.05 ) . Duration of fever was significantly prolonged in the GAP patients ( 4.7 + /- .8 days versus 2.9 + /- .5 days ) when compared to the clindamycin treated children ( P less than 0.05 ) . Duration of leukocytosis was 3.2 + /- .4 days for GAC patients and 4.9 + /- .9 days for those on the GAP protocol ( P = 0.08 ) . On the basis of this experience the routine use of gentamicin , ampicillin , and clindamycin is recommended for all children with complicated appendicitis A prospect i ve study was conducted on 344 children aged from 3 months to 16 years with acute appendicitis . Most children presented with typical features of acute appendicitis ( 70 % ) or peritonitis ( 28 % ) . Atypical presentation was uncommon and occurred only in seven young children , masquerading as intestinal obstruction , gastroenteritis or urinary tract infection . Prolonged delay in surgery was associated with a rise in incidence of late appendicitis ( gangrenous and perforated appendicitis ) . This rise was especially marked 37 h after onset of symptoms . The main causes of delay were inability of the parents and primary care medical practitioners to recognize the disease early . Surgeons contributed very little to the delay . High risk factors for postappendectomy sepsis were young children under 6 years old , late appendicitis , obese patients , inferior systemic antibiotic regimes and inexperienced surgeons . Young children had high postoperative sepsis mainly because of the high incidence of late appendicitis due to their inability to express their symptoms properly . They were not especially prone to postappendectomy sepsis ; they had the same degree of appendicitis compared with older children . Measures to decrease the postappendectomy morbidity are suggested 60 consecutive children operated for perforated appendicitis were treated r and omly with either penicillin and streptomycin or with clindamycin and gentamycin .  Suppurative complications occurred somewhat more often and were definitely more severe in the former group . The number of hospital days spent in the treatment of these complications were three times as great in the former than in the latter group . Bacteroides fragilis could be isolated in most of the severe infections treated without clindamycin . Two out of 28 patients treated with clindamycin presented with severe diarrhoea BACKGROUND / PURPOSE Controversy persists in the management of perforated appendicitis with regard to antibiotic choice and duration , operative timing , drain utilization , and wound closure . For 2 decades at the authors ' institution , patients were treated with ampicillin , gentamicin , and clindamycin for 10 inpatient days , with drains in the abdomen , result ing in lower complication rates than most other published series . Managed care pressures have led to less aggressive medical management regimens with length of stay and financial factors viewed as principal outcome measures with little emphasis on clinical outcomes . In addition , there are little prospect i ve data on clinical outcomes . The authors sought to determine whether our previously documented excellent quality outcomes could be maintained when modifications aim ed at decreasing cost and length of stay in our protocol were instituted . METHODS The authors monitored prospect ively clinical outcomes in patients with perforated appendicitis treated according to their clinical practice guidelines over a 43-month period . Patients received a single antibiotic , piperacillin-tazobactam , intravenously for 10 days . They were permitted to go home with a percutaneous intravenous catheter for the final 5 days if medical and social criteria were met . Other practice s from our earlier protocol were continued , including immediate operation , placement of Penrose drains , and primary wound closure . RESULTS Of 150 patients treated on our protocol , major complications included intraabdominal abscess in 5 ( 3.3 % ) , cecal fistula in 2 ( 1.3 % ) , phlegmon in 3 ( 2.0 % ) , wound infection in 4 ( 2.7 % ) , and no small bowel obstructions requiring operation . None of these complications , nor their aggregate , were significantly more common than those reported in 373 patients treated over 11 years on the authors ' prior protocol ( chi2 , P > .05 ) . CONCLUSIONS Prospect i ve outcome analysis of our protocol shows that a single broad-spectrum antibiotic ( allowing portions of therapy to be delivered less expensively on an outpatient basis ) effectively can treat postoperative appendicitis with very few infectious complications . These outcome data provide baseline against which future protocol s can be compared . All treatment modifications aim ed at decreasing costs must be analyzed to ensure quality of care is not unduly compromised In a multicentre trial we compared the clinical efficacy of amoxicillin/clavulanate used as a single-agent therapy with that of the three-agent combination usually prescribed in the post-operative period for appendicular peritonitis in children . Only bacteriologically documented peritoneal infections were included . Sixty-four patients were r and omly distributed between two groups : Group A ( 29 cases ) treated with amoxicillin/clavulanate , first administered iv ( 100 mg/kg/d ) , followed by conversion to the oral route ( 50 mg/kg/d ) once the patient had been afebrile for 48 hours ; Group B ( 35 cases ) first treated by the iv route with benzylpenicillin ( 100,000 IU/kg/d ) plus netilmicin ( 5 mg/kg/d ) plus metronidazole ( 30 mg/kg/d ) , followed by conversion to the oral route for metronidazole ( 30 mg/kg/d ) . In both groups , the total duration of parenteral and oral treatment was not less than 5 days . One hundred and seventy nine bacterial strains were recovered from peritoneal fluid sample s obtained during surgery ; 86 % of these were sensitive to amoxicillin/clavulanate .  Clinical efficacy , assessed on the basis of time until return to normal temperature and gut transit and duration of hospitalization , was identical in both groups , with follow-up monitoring on day 30 showing recovery in all cases . Cure was obtained without any problems of infection in 25/29 patients in group A and in 34/35 patients in group B ( non significant difference ) . Tolerance was excellent and identical in the two groups with the exception of three cases of thrombophlebitis which occurred in group B. The results of this study suggest that amoxicillin/clavulanate may be useful as single-agent therapy as a first-line curative treatment for appendicular peritonitis in children Optimal management of children with perforated appendicitis remains a controversial clinical problem . Until very recently , the criteria for hospital discharge on our surgical service included the absence of fever and leukocytosis for a period of 48 hours following completion of antimicrobial therapy , uncomplicated wound healing , a normal rectal examination , and unimpaired gastrointestinal function . With the introduction of cost-containment programs , the necessity for the period of inpatient observation following cessation of antibiotics was question ed . The records of 87 consecutive children with perforated appendicitis were analyzed prospect ively in order to determine if our discharge policies were medically sound and cost-effective . Seventy-five patients ( 86 % ) recovered uneventfully while 12 children required prolonged hospitalization for management of various postoperative complications . The 12 patients who developed complications were all identifiable early in the postoperative period because of persistent fever , leukocytosis , and elevated b and counts . Of the 75 children who recovered uneventfully , all met st and ard discharge criteria on the final day of antibiotic therapy with the exception of completing the m and atory 48-hour period of inpatient observation . These children were maintained in the hospital a total of 142 additional days following discontinuation of antibiotics . The average cost per patient day for children with perforated appendicitis during the study period was $ 506.32 , which represented unnecessary hospital charges of $ 71,897.44 . It was concluded that inpatient observation following cessation of antibiotic therapy in children who experience an uneventful recovery from perforated appendicitis is neither necessary nor cost-effective . ( ABSTRACT TRUNCATED AT 250 WORDS Although single antimicrobials with broad-spectrum aerobic and anaerobic coverage are effective in patients with appendicitis , many 
    Output:
    