Antibiotic monotherapy vs dual-drug therapy in perforated appendicitis: single-center retrospective review.
Document Type
Article
Publication Date
7-22-2025
Identifier
DOI: 10.1007/s00383-025-06129-0
Abstract
BACKGROUND: There is no consensus on the optimal antibiotic regimen in perforated appendicitis. We aimed to evaluate the outcomes of patients with perforated appendicitis when treated with Piperacillin-Tazobactam (PT) monotherapy versus Ceftriaxone and Metronidazole (CM) dual-drug therapy. We hypothesized that there is no difference in the rate of intraabdominal abscess (IAA) formation with antibiotic monotherapy, as opposed to our institutional standard dual-drug therapy.
METHODS: Single institution retrospective review of children < 18 years old with perforated appendicitis from October 2019 to March 2020 and October 2021 to May 2022 at a free-standing pediatric hospital. The primary outcome was 30-day postoperative IAA formation.
RESULTS: One hundred and seventeen patients were identified during the study periods; N = 77 in the CM group and N = 40 in the PT group. No differences in symptom duration, postoperative length of stay (LOS), duration of intravenous antibiotic treatment, or discharge oral antibiotic treatment were identified. Compared to the PT group, those treated with CM had fewer IAA (13% vs 20%, P = 0.32) and fewer emergency room visits (14.3% vs 27.5%, P = 0.08) but did not have statistically significant differences. Multivariate logistic regression analysis did not find antibiotic choice to be a significant predictor for developing IAA [OR 1.78, P = 0.21].
CONCLUSIONS: In children with perforated appendicitis, postoperative monotherapy with PT and standard dual-drug therapy with CM are equivalent with respect to IAA formation at our institution.
Journal Title
Pediatric surgery international
Volume
41
Issue
1
First Page
225
Last Page
225
MeSH Keywords
Humans; Appendicitis; Retrospective Studies; Male; Anti-Bacterial Agents; Female; Child; Piperacillin, Tazobactam Drug Combination; Drug Therapy, Combination; Metronidazole; Ceftriaxone; Abdominal Abscess; Adolescent; Child, Preschool; Treatment Outcome
PubMed ID
40694142
Keywords
Abscess; Appendicitis; Ceftriaxone; Metronidazole; Rocephin flagyl; Zosyn
Recommended Citation
Stewart S, Nonnemacher C, Saylors S, et al. Antibiotic monotherapy vs dual-drug therapy in perforated appendicitis: single-center retrospective review. Pediatr Surg Int. 2025;41(1):225. Published 2025 Jul 22. doi:10.1007/s00383-025-06129-0
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