Combined therapy in post-operative gas gangrene.

Abstract

Summary A case of gas gangrene arising as a complication of exploratory ureterotomy in a patient with chronic bilateral renal infection is described. The bacteriological diagnosis was established on the second day after onset; a toxigenic strain of Clostridium welchii type A was isolated from the wound. Proteus mirabilis was isolated from the wound and from the patient's bloodstream. Combined therapy included prompt surgical treatment and repeated local instillations of H2O2 and a saline solution containing 1000 IU penicillin per ml. Parenteral antibiotic therapy included 20 M.units of penicillin daily, and pyrrolidinomethy 1 tetracycline and spiramycin. A dose of 10,000 units of CI. welchii antitoxin was given intravenously in a polyvalent clostridial antitoxic serum, followed by 30,000 units as monovalent serum when the diagnosis was confirmed. The patient's condition improved dramatically within a few hours of the start of the combined therapy and recovery was complete within 8 days. The pathogenesis, diagnosis and current methods of treatment of gas gangrene are discussed, with special reference to post-operative gas gangrene.