http://archsurg.jamanetwork.com/ en-us Wed, 26 Dec 2012 00:00:00 GMT Tue, 01 Jan 2013 00:51:15 GMT Silverchair editor@archsurg.jamanetwork.com webmaster@archsurg.jamanetwork.com http://archsurg.jamanetwork.com/article.aspx?articleID=405718 Mon, 01 Feb 2010 00:00:00 GMT St. Peter SD, Sharp SW, Ostlie DJ. <span class="paragraphSection"><div class="boxTitle">Hypothesis</div>Diphenhydramine blocks the H₁ receptor to treat pruritus or to induce sleep, while ranitidine blocks the H₂ receptor to suppress gastric acid. They are often given to ill patients, such as those with perforated appendicitis. However, these receptors are integral to the inflammatory response, and to our knowledge, the impact of H₁ or H₂ blockade on outcome in the setting of perforated appendicitis has never been evaluated.<div class="boxTitle">Design</div>Prospective randomized trial.<div class="boxTitle">Setting</div>Referral center.<div class="boxTitle">Patients</div>Children undergoing an operation for perforated appendicitis from April 2005 to November 2006.<div class="boxTitle">Main Outcome Measures</div>We conducted multivariate analysis with Pearson correlation on data from a prospective randomized trial comparing antibiotic regimen after appendectomy for perforated appendicitis and outcome. Medications with a significant correlation to abscess development were investigated by comparing those receiving the medication with those who did not using the <span style="font-style:italic;">t</span> test for continuous variables and χ² test for discrete variables. Significance was defined as <span style="font-style:italic;">P</span> ≤ .05.<div class="boxTitle">Results</div>Significant correlations were found between the use of ranitidine (<span style="font-style:italic;">P</span> = .05) or diphenhydramine (<span style="font-style:italic;">P</span> = .03) and the development of an abscess. Direct comparison found no differences in patient or operative variables in those given either medication compared with those receiving no doses. Abscess rate in those receiving neither medication (n = 41) was 10%. Those given only ranitidine (n = 24) or diphenhydramine (n = 17) had doubled abscess rates of 17% and 18%, respectively. Those given both medications (n = 16) had a quadrupled abscess rate of 44% (<span style="font-style:italic;">P</span> = .03).<div class="boxTitle">Conclusions</div>Ranitidine or diphenhydramine given to patients with perforated appendicitis may increase the risk of postoperative abscess. Therefore, these medications should not be used empirically in this population.</span> 145 2 143 146 10.1001/archsurg.2009.258 http://archsurg.jamanetwork.com/article.aspx?articleID=405718