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

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.

• Authors: Jason D Fraser, Pablo Aguayo, Charles M Leys, Scott J Keckler, Jason G Newland, Susan W Sharp, John P Murphy, Charles L Snyder, Ronald J Sharp, Walter S Andrews, George W Holcomb 3rd, Daniel J Ostlie, Shawn D St Peter
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 45 Issue 6 Pg. 1198-202 (Jun 2010) ISSN: 1531-5037 [Electronic] United States
• PMID: 20620320 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright 2010 Elsevier Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Metronidazole
• Ceftriaxone
• Amoxicillin

Topics

• Administration, Oral
• Amoxicillin (administration & dosage)
• Anti-Bacterial Agents (administration & dosage)
• Appendectomy (methods)
• Appendicitis (diagnosis, drug therapy, surgery)
• Ceftriaxone (administration & dosage)
• Child
• Dose-Response Relationship, Drug
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Humans
• Injections, Intravenous
• Laparoscopy
• Male
• Metronidazole (administration & dosage)
• Preoperative Care (methods)
• Prospective Studies
• Rupture, Spontaneous
• Treatment Outcome