Single daily dosing ceftriaxone and metronidazole vs standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomized trial.

Creator(s)

Shawn D. St Peter, Children's Mercy HospitalFollow
Kuojen Tsao
Troy L. Spilde
G W. Holcomb III, Children's Mercy HospitalFollow
Susan W. Sharp
J Patrick Murphy
Charles L. Snyder, Children's Mercy HospitalFollow
Ronald J. Sharp
Walter S. Andrews, Children's Mercy HospitalFollow
Daniel J. Ostlie

Document Type

Article

Publication Date

6-1-2008

Identifier

PMCID: PMC3082440 DOI: 10.1016/j.jpedsurg.2008.02.018

Abstract

INTRODUCTION: Appendicitis is the most common emergency condition in children. Historically, a 3-drug regimen consisting of ampicillin, gentamicin, and clindamycin (AGC) has been used postoperatively for perforated appendicitis. A retrospective review at our institution has found single day dosing of ceftriaxone and metronidazole (CM) to be a more simple and cost-effective antibiotic strategy. Therefore, we performed a prospective, randomized trial to compare efficacy and cost-effectiveness of these 2 regimens.

METHODS: After internal review board approval (IRB no. 04 12-149), children found to have perforated appendicitis at appendectomy were randomized to either once daily dosing of CM (2 total doses per day) or standard dosing of AGC (11 total doses per day). Perforation was defined as an identifiable hole in the appendix. The operative approach (laparoscopic), length of antibiotic use, and criteria for discharge were standardized for the groups. Based on our retrospective analysis using length of postoperative hospitalization as a primary end point, a sample size of 100 patients was calculated for an alpha of .5 and a power of 0.82.

RESULTS: One hundred patients underwent laparoscopic appendectomy for perforated appendicitis. On presentation, there were no differences in sex distribution, days of symptoms, temperature, or leukocyte count. There was no difference in abscess rate or wound infections between groups. The CM group resulted in significantly less antibiotic charges then the AGC group.

CONCLUSIONS: Once daily dosing with the 2-drug regimen (CM) offers a more efficient, cost-effective antibiotic management in children with perforated appendicitis without compromising infection control when compared to a traditional 3-drug regimen.

Journal Title

Journal of pediatric surgery

Volume

43

Issue

6

First Page

981

Last Page

985

MeSH Keywords

Abscess; Administration, Oral; Adolescent; Antibiotic Prophylaxis; Appendectomy; Appendicitis; Ceftriaxone; Child; Cost-Benefit Analysis; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Gentamicins; Hospital Costs; Humans; Infusions, Intravenous; Male; Metronidazole; Multivariate Analysis; Probability; Prospective Studies; Treatment Outcome

Keywords

Appendicitis; Drug Administration Schedule; Antibiotic

Comments

Comment in

• Considerations about the article by St. Peter "Single daily dosing ceftriaxone and metronidazole vs standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomised trial". J Pediatr Surg 2008;43:981-985. [J Pediatr Surg. 2008]

Recommended Citation

St Peter, S. D., Tsao, K., Spilde, T. L., Holcomb, G. W., Sharp, S. W., Murphy, J. P., Snyder, C. L., Sharp, R. J., Andrews, W. S., Ostlie, D. J. Single daily dosing ceftriaxone and metronidazole vs standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomized trial. Journal of pediatric surgery 43, 981-985 (2008).