Audit of antibiotic therapy in surgical neonates in a tertiary hospital in Benin City, Nigeria.

OBJECTIVE: To report the outcome of commonly used antibiotic combinations in surgical neonates in sub-Saharan African settings. METHODS: A retrospective analysis that determines the outcome of commonly combined antibiotics in surgical neonates between January 2006 and December 2008 at two referral paediatric surgical centres in Benin city was carried out. RESULTS: Ampicillin ampiclox, metronidazole, gentamicin, cefuroxime and ceftriaxone were variously combined in the management of 161 neonates with a mean age at presentation of 9.2 ± 2.6 days, mean weight 3.1 ± 1.4 kg and a male:female ratio 1.6:1. Polymicrobial postoperative wound infections and sepsis caused by Staphylococcus aureus, Escherichia coli, Neisseria meningitidis, Klebsiella pneumonia, Pseudomonas aeroginosa and anaerobes, were mainly encountered. The most common aerobes isolated from wound cultures were S. aureus and P. aeroginosa while the ones from that of blood cultures were E. coli and K. pneumonia. Overall postoperative infections recorded were: wound infection 19 (11.8%), sepsis 16 (9.9%) and sepsis-related deaths 6 (3.7%). CONCLUSION: Combinations of gentamicin/metronidazole/cefuroxime and gentamicin/cefuroxime were adequate for gastrointestinal and extra-gastrointestinal neonatal operations, respectively, in these sub-Saharan African settings, which may be useful in similar regions.

Audit of antibiotic therapy in surgical neonates in a tertiary hospital in Benin City, Nigeria

Objective: To report the outcome of commonly used antibiotic combinations in surgical neonates in sub-Saharan African settings. Methods: A retrospective analysis that determines the outcome of commonly combined antibiotics in surgical neonates between January 2006 and December 2008 at two referral paediatric surgical centres in Benin city was carried out. Results: Ampicillin ampiclox, metronidazole, gentamicin, cefuroxime and ceftriaxone were variously combined in the management of 161 neonates with a mean age at presentation of 9.2 ± 2.6 days, mean weight 3.1 ± 1.4 kg and a male:female ratio 1.6:1. Polymicrobial postoperative wound infections and sepsis caused by Staphylococcus aureus, Escherichia coli, Neisseria meningitidis, Klebsiella pneumonia, Pseudomonas aeroginosa and anaerobes, were mainly encountered. The most common aerobes isolated from wound cultures were S. aureus and P. aeroginosa while the ones from that of blood cultures were E. coli and K. pneumonia. Overall postoperative infections recorded were: wound infection 19 (11.8%), sepsis 16 (9.9%) and sepsis-related deaths 6 (3.7%). Conclusion: Combinations of gentamicin/metronidazole/cefuroxime and gentamicin/cefuroxime were adequate for gastrointestinal and extra-gastrointestinal neonatal operations, respectively, in these sub-Saharan African settings, which may be useful in similar regions

Safety profile of parenteral ketamine and lignocaine infiltration in pediatric operations.

OBJECTIVE: To study the safety and benefits of parenteral ketamine and lignocaine infiltration among pediatric surgical patients with co-morbidities that would preclude the use of general anesthesia requiring endotracheal intubation/face mask in a developing country. METHODS: This prospective study was undertaken at the Leadeks Medical Centre, Benin City Edo State, Nigeria between January 2002 and December 2006. Patients requiring surgery were safely operated even in the presence of co-morbidity. RESULTS: A total of 416 children were recruited and they were aged 6 days to 16 years (mean 12 -/+ 2.04 years) with a male/female ratio of 1:1.1. Appendectomy (33.2%), herniotomy (20.2%) and suturing of laceration (15.9%) were the most common indications for surgery. Anemia, upper respiratory tract infections, malnutrition, malaria fever, typhoid fever, and retroviral infections were co-morbidities. Ambulatory surgery was carried out in 48.6% patients. Overall, only 23.3% experienced postoperative pain, which was statistically significant in those that had laparotomy and appendectomy (p<0.0001), and analgesics such as paracetamol were enough to relieve the pain. Complications recorded such as postoperative vomiting, emergence reaction, wound infection, post operative fever, and apnea occurring after ketamine injections were tolerated and no mortality was recorded. CONCLUSION: The satisfactory anesthesia and analgesia recorded with this combination, and the low complications observed in the presence of co-morbidity showed that these agents have much to offer in a developing country.