Home Intravenous Versus Oral Antibiotics Following Appendectomy for Perforated Appendicitis in Children: a Randomized Controlled Trial

Overview

Journal Pediatr Surg Int

Specialties General Surgery
Pediatrics

Date 2018 Sep 16

PMID 30218170

Citations 9

Authors

Michael R Arnold

Blair A Wormer

Angela M Kao

David A Klima

Paul D Colavita

Graham H Cosper

Brant Todd Heniford

Andrew M Schulman

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare the effect of home intravenous (IV) versus oral antibiotic therapy on complication rates and resource utilization following appendectomy for perforated appendicitis.

Methods: This was a randomized controlled trial of patients aged 4-17 with surgically treated perforated appendicitis from January 2011 to November 2013. Perforation was defined intraoperatively and divided into three grades: I-contained perforation, II-localized contamination to right gutter/pelvis, and III-diffuse contamination. Patients were randomized to complete a ten-day course of home antibiotic therapy with either IV ertapenem or oral amoxicillin-clavulanate. Thirty-day postoperative complication rates including abscess, readmission, wound infection, and charges were compared.

Results: Eighty-two patients were enrolled. Forty four (54%) were randomized to the IV group and 38 (46%) to the oral group. IV patients were older (12.3 ± 3.6 versus 10.1 ± 3.6, p < 0.05) with higher BMI (20.9 ± 5.8 versus 17.9 ± 3.5, p < 0.05). There were no differences in gender, comorbidities, or perforation grade (I-20.4% vs. 26.3%, II-36.4% vs. 34.2%, III-43.2% vs. 39.5%, all p > 0.05). Comparing IV to oral, there was no difference in length of stay (4.4 ± 1.5 versus 4.4 ± 2.0 days, p > 0.05), postoperative abscess rate (11.6% vs. 8.1%, p > 0.05), or readmission rate (14.0% vs. 16.2%, p > 0.05). Hospital and outpatient charges were higher in the IV group (p < 0.0001).

Conclusion: Oral antibiotics had equivalent outcomes and incurred fewer charges than IV antibiotics following appendectomy for perforated appendicitis.

Citing Articles

Perforated Appendicitis in Children: Management, Microbiology, and Antibiotic Stewardship.

Snyder K, Hunter C, Buonpane C Paediatr Drugs. 2024; 26(3):277-286.

PMID: 38653916 DOI: 10.1007/s40272-024-00630-0.

Pediatric perforated appendicitis diagnosis based on the C-reactive protein/prealbumin ratio.

Long J, Zhang J, Chen G, Su X, Qiu B, Dong Q Sci Rep. 2024; 14(1):6729.

PMID: 38509094 PMC: 10954718. DOI: 10.1038/s41598-024-55108-3.

Effectiveness of ertapenem for treatment of infections in children: An evidence mapping and meta-analysis.

Zhao R, Long X, Wang J, Zhu J, Liu C, Shang T Front Pediatr. 2022; 10:982179.

PMID: 36324821 PMC: 9620802. DOI: 10.3389/fped.2022.982179.

Opinion-Based Recommendations: Beware the Tyranny of Experts.

Spellberg B, Shorr A Open Forum Infect Dis. 2021; 8(11):ofab490.

PMID: 34805432 PMC: 8599712. DOI: 10.1093/ofid/ofab490.

Management and Microbiology of Perforated Appendicitis in Pediatric Patients: A 5-Year Retrospective Study.

Plattner A, Newland J, Wallendorf M, Shakhsheer B Infect Dis Ther. 2021; 10(4):2247-2257.

PMID: 34287780 PMC: 8572942. DOI: 10.1007/s40121-021-00502-x.

References

Solomkin J, Mazuski J, Bradley J, Rodvold K, Goldstein E, Baron E . Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect (Larchmt). 2010; 11(1):79-109. DOI: 10.1089/sur.2009.9930. View

Marty Knott E, Gasior A, Ostlie D, Holcomb 3rd G, St Peter S . Decreased resource utilization since initiation of institutional clinical pathway for care of children with perforated appendicitis. J Pediatr Surg. 2013; 48(6):1395-8. DOI: 10.1016/j.jpedsurg.2013.03.044. View

Fraser J, Aguayo P, Leys C, Keckler S, Newland J, Sharp S . A complete course of intravenous antibiotics vs a combination of intravenous and oral antibiotics for perforated appendicitis in children: a prospective, randomized trial. J Pediatr Surg. 2010; 45(6):1198-202. DOI: 10.1016/j.jpedsurg.2010.02.090. View

Henry M, Walker A, Silverman B, Gollin G, Islam S, Sylvester K . Risk factors for the development of abdominal abscess following operation for perforated appendicitis in children: a multicenter case-control study. Arch Surg. 2007; 142(3):236-41. DOI: 10.1001/archsurg.142.3.236. View

Fike F, Mortellaro V, Juang D, Sharp S, Ostlie D, St Peter S . The impact of postoperative abscess formation in perforated appendicitis. J Surg Res. 2011; 170(1):24-6. DOI: 10.1016/j.jss.2011.03.038. View

Rodriguez J, Buckner D, Schoenike S, Gomez-Marin O, Oiticica C, Thompson W . Comparison of two antibiotic regimens in the treatment of perforated appendicitis in pediatric patients. Int J Clin Pharmacol Ther. 2000; 38(10):492-9. DOI: 10.5414/cpp38492. View

Adibe O, Barnaby K, Dobies J, Comerford M, Drill A, Walker N . Postoperative antibiotic therapy for children with perforated appendicitis: long course of intravenous antibiotics versus early conversion to an oral regimen. Am J Surg. 2007; 195(2):141-3. DOI: 10.1016/j.amjsurg.2007.10.002. View

St Peter S, Sharp S, Holcomb 3rd G, Ostlie D . An evidence-based definition for perforated appendicitis derived from a prospective randomized trial. J Pediatr Surg. 2008; 43(12):2242-5. DOI: 10.1016/j.jpedsurg.2008.08.051. View

Dennett K, Tracy S, Fisher S, Charron G, Zurakowski D, Calvert C . Treatment of perforated appendicitis in children: what is the cost?. J Pediatr Surg. 2012; 47(6):1177-84. DOI: 10.1016/j.jpedsurg.2012.03.024. View

10.

St Peter S, Tsao K, Spilde T, Holcomb 3rd G, Sharp S, Murphy J . Single daily dosing ceftriaxone and metronidazole vs standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomized trial. J Pediatr Surg. 2008; 43(6):981-5. PMC: 3082440. DOI: 10.1016/j.jpedsurg.2008.02.018. View

11.

Goldin A, Sawin R, Garrison M, Zerr D, Christakis D . Aminoglycoside-based triple-antibiotic therapy versus monotherapy for children with ruptured appendicitis. Pediatrics. 2007; 119(5):905-11. DOI: 10.1542/peds.2006-2040. View

12.

Rice H, Brown R, Gollin G, Caty M, Gilbert J, Skinner M . Results of a pilot trial comparing prolonged intravenous antibiotics with sequential intravenous/oral antibiotics for children with perforated appendicitis. Arch Surg. 2001; 136(12):1391-5. DOI: 10.1001/archsurg.136.12.1391. View

13.

Curran T, Muenchow S . The treatment of complicated appendicitis in children using peritoneal drainage: results from a public hospital. J Pediatr Surg. 1993; 28(2):204-8. DOI: 10.1016/s0022-3468(05)80276-3. View

14.

Muehlstedt S, Pham T, Schmeling D . The management of pediatric appendicitis: a survey of North American Pediatric Surgeons. J Pediatr Surg. 2004; 39(6):875-9. DOI: 10.1016/j.jpedsurg.2004.02.035. View

15.

Dennett K, Tracy S, Zurakowski D, Calvert C, Chen C . Impact on family of management strategies for perforated appendicitis in children. J Pediatr Surg. 2012; 47(10):1900-6. DOI: 10.1016/j.jpedsurg.2012.06.004. View

16.

Lee S, Islam S, Cassidy L, Abdullah F, Arca M . Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg. 2010; 45(11):2181-5. DOI: 10.1016/j.jpedsurg.2010.06.038. View