Home intravenous versus oral antibiotics following appendectomy for perforated appendicitis in children: a randomized controlled trial
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To compare the effect of home intravenous (IV) versus oral antibiotic therapy on complication rates and resource utilization following appendectomy for perforated appendicitis.
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.
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).
Oral antibiotics had equivalent outcomes and incurred fewer charges than IV antibiotics following appendectomy for perforated appendicitis.
KeywordsPerforated appendicitis Discharge antibiotics Children Pediatric Complicated appendicitis
Compliance with ethical standards
Conflict of interest
Dr. Heniford has prior grants and honoraria from W.L. Gore, Allergan, and Stryker. These are not relevant to this paper. All other authors have nothing to disclose.
Research involving human participants and/or animals
The following paper discusses research on human subjects, by one group practicing at two separate medical centers. Both centers’ institutional review boards approved this study. Presbyterian Healthcare IRB# 10056 and Carolinas Healthcare System IRB# 08-10-13B.
As a prospective randomized controlled trial, all subjects were enrolled with informed consent provided by the parents. This consent form was approved per IRB standards and approved by the above listed institutions.
- 5.Henry MC, Walker A, Silverman BL, Gollin G, Islam S, Sylvester K, Moss RL (2007) Risk factors for the development of abdominal abscess following operation for perforated appendicitis in children: a multicenter case-control study. Arch Surg 142(3):236–241. https://doi.org/10.1001/archsurg.142.3.236 (discussion 241) CrossRefPubMedGoogle Scholar
- 7.Adibe OO, Barnaby K, Dobies J, Comerford M, Drill A, Walker N, Mattei P (2008) Postoperative antibiotic therapy for children with perforated appendicitis: long course of intravenous antibiotics versus early conversion to an oral regimen. Am J Surg 195(2):141–143. https://doi.org/10.1016/j.amjsurg.2007.10.002 CrossRefPubMedGoogle Scholar
- 8.Fraser JD, Aguayo P, Leys CM, Keckler SJ, Newland JG, Sharp SW, Murphy JP, Snyder CL, Sharp RJ, Andrews WS, Holcomb GW 3rd, Ostlie DJ, St Peter SD (2010) 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 45(6):1198–1202. https://doi.org/10.1016/j.jpedsurg.2010.02.090 CrossRefPubMedGoogle Scholar
- 10.Lee SL, Islam S, Cassidy LD, Abdullah F, Arca MJ (2010) Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg 45(11):2181–2185. https://doi.org/10.1016/j.jpedsurg.2010.06.038 CrossRefPubMedGoogle Scholar
- 11.Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O’Neill PJ, Chow AW, Dellinger EP, Eachempati SR, Gorbach S, Hilfiker M, May AK, Nathens AB, Sawyer RG, Bartlett JG (2010) 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) 11(1):79–109. https://doi.org/10.1089/sur.2009.9930 CrossRefGoogle Scholar
- 14.St Peter SD, Tsao K, Spilde TL, Holcomb GW 3rd, Sharp SW, Murphy JP, Snyder CL, Sharp RJ, Andrews WS, Ostlie DJ (2008) Single daily dosing ceftriaxone and metronidazole vs standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomized trial. J Pediatr Surg 43(6):981–985. https://doi.org/10.1016/j.jpedsurg.2008.02.018 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Knott EM, Gasior AC, Ostlie DJ, Holcomb GW 3rd, St Peter SD (2013) Decreased resource utilization since initiation of institutional clinical pathway for care of children with perforated appendicitis. J Pediatr Surg 48(6):1395–1398. https://doi.org/10.1016/j.jpedsurg.2013.03.044 CrossRefPubMedGoogle Scholar