A complete course of intravenous antibiotics vs a combination of intravenous and oral antibiotics for perforated appendicitis in children: a prospective, randomized trial.

Creator(s)

Jason D. Fraser, Children's Mercy HospitalFollow
Pablo Aguayo, Children's Mercy HospitalFollow
Charles M. Leys
Scott J. Keckler
Jason G. Newland
Susan W. Sharp
John P. Murphy
Charles L. Snyder, Children's Mercy HospitalFollow
Ronald J. Sharp
Walter S. Andrews, Children's Mercy HospitalFollow
G W. Holcomb III, Children's Mercy HospitalFollow
Daniel J. Ostlie
Shawn D. St Peter, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

6-1-2010

Identifier

DOI: 10.1016/j.jpedsurg.2010.02.090

Abstract

INTRODUCTION: In a previous prospective randomized trial, we found a once-a-day regimen of ceftriaxone and metronidazole to be an efficient, cost-effective treatment for children with perforated appendicitis. In this study, we evaluated the safety of discharging patients to complete an oral course of antibiotics.

METHODS: Children found to have perforated appendicitis at the time of laparoscopic appendectomy were enrolled in the study. Perforation was defined as a hole in the appendix or fecalith in the abdomen. Patients were randomized to antibiotic treatment with either once daily dosing of ceftriaxone and metronidazole for a minimum of 5 days (intravenous [IV] arm) or discharge to home on oral amoxicillin/clavulanate when tolerating a regular diet (IV/PO arm) to complete 7 days.

RESULTS: One hundred two patients underwent laparoscopic appendectomy for perforated appendicitis. On presentation, there were no differences in age, weight, sex distribution, days of symptoms, maximum temperature, or leukocyte count between the 2 groups. There was no difference in the postoperative abscess rate between the two treatment groups. Discharge was possible before day 5 in 42% of the patients in the IV/PO arm.

CONCLUSIONS: When patients are able to tolerate a regular diet, completing the course of antibiotics orally decreases hospitalization with no effect on the risk of postoperative abscess formation.

Journal Title

Journal of pediatric surgery

Volume

45

Issue

6

First Page

1198

Last Page

1202

MeSH Keywords

Administration, Oral; Amoxicillin; Anti-Bacterial Agents; Appendectomy; Appendicitis; Ceftriaxone; Child; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Injections, Intravenous; Laparoscopy; Male; Metronidazole; Preoperative Care; Prospective Studies; Rupture, Spontaneous; Treatment Outcome

Keywords

Antibiotic administration; appendectomy; Appendicitis

Recommended Citation

Fraser, J. D., Aguayo, P., Leys, C. M., Keckler, S. J., Newland, J. G., Sharp, S. W., Murphy, J. P., Snyder, C. L., Sharp, R. J., Andrews, W. S., Holcomb, G. W., Ostlie, D. J., St Peter, S. D. A complete course of intravenous antibiotics vs a combination of intravenous and oral antibiotics for perforated appendicitis in children: a prospective, randomized trial. Journal of pediatric surgery 45, 1198-1202 (2010).