Advertisement

Home intravenous versus oral antibiotics following appendectomy for perforated appendicitis in children: a randomized controlled trial

  • Michael R. Arnold
  • Blair A. Wormer
  • Angela M. Kao
  • David A. Klima
  • Paul D. Colavita
  • Graham H. Cosper
  • Brant Todd Heniford
  • Andrew M. Schulman
Original Article
  • 48 Downloads

Abstract

Purpose

To compare the effect of home intravenous (IV) versus oral antibiotic therapy on complication rates and resource utilization following appendectomy for perforated appendicitis.

Methods

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.

Results

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).

Conclusion

Oral antibiotics had equivalent outcomes and incurred fewer charges than IV antibiotics following appendectomy for perforated appendicitis.

Keywords

Perforated appendicitis Discharge antibiotics Children Pediatric Complicated appendicitis 

Notes

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.

Informed consent

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.

References

  1. 1.
    Goldin AB, Sawin RS, Garrison MM, Zerr DM, Christakis DA (2007) Aminoglycoside-based triple-antibiotic therapy versus monotherapy for children with ruptured appendicitis. Pediatrics 119(5):905–911.  https://doi.org/10.1542/peds.2006-2040 CrossRefPubMedGoogle Scholar
  2. 2.
    Curran TJ, Muenchow SK (1993) The treatment of complicated appendicitis in children using peritoneal drainage: results from a public hospital. J Pediatr Surg 28(2):204–208CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Dennett KV, Tracy S, Fisher S, Charron G, Zurakowski D, Calvert CE, Chen C (2012) Treatment of perforated appendicitis in children: what is the cost? J Pediatr Surg 47(6):1177–1184.  https://doi.org/10.1016/j.jpedsurg.2012.03.024 CrossRefPubMedGoogle Scholar
  4. 4.
    Dennett KV, Tracy S, Zurakowski D, Calvert CE, Chen C (2012) Impact on family of management strategies for perforated appendicitis in children. J Pediatr Surg 47(10):1900–1906.  https://doi.org/10.1016/j.jpedsurg.2012.06.004 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 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) CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Fike FB, Mortellaro VE, Juang D, Sharp SW, Ostlie DJ, St Peter SD (2011) The impact of postoperative abscess formation in perforated appendicitis. J Surg Res 170(1):24–26.  https://doi.org/10.1016/j.jss.2011.03.038 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Muehlstedt SG, Pham TQ, Schmeling DJ (2004) The management of pediatric appendicitis: a survey of North American Pediatric Surgeons. J Pediatr Surg 39(6):875–879 (discussion 875–879) CrossRefPubMedCentralGoogle Scholar
  10. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 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
  12. 12.
    Rodriguez JC, Buckner D, Schoenike S, Gomez-Marin O, Oiticica C, Thompson WR (2000) Comparison of two antibiotic regimens in the treatment of perforated appendicitis in pediatric patients. Int J Clin Pharmacol Ther 38(10):492–499CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Rice HE, Brown RL, Gollin G, Caty MG, Gilbert J, Skinner MA, Glick PL, Azizkhan RG (2001) Results of a pilot trial comparing prolonged intravenous antibiotics with sequential intravenous/oral antibiotics for children with perforated appendicitis. Arch Surg 136(12):1391–1395CrossRefPubMedCentralGoogle Scholar
  14. 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. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    St Peter SD, Sharp SW, Holcomb GW 3rd, Ostlie DJ (2008) An evidence-based definition for perforated appendicitis derived from a prospective randomized trial. J Pediatr Surg 43(12):2242–2245.  https://doi.org/10.1016/j.jpedsurg.2008.08.051 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Michael R. Arnold
    • 1
  • Blair A. Wormer
    • 1
  • Angela M. Kao
    • 1
  • David A. Klima
    • 1
  • Paul D. Colavita
    • 1
  • Graham H. Cosper
    • 1
    • 2
    • 3
  • Brant Todd Heniford
    • 1
  • Andrew M. Schulman
    • 1
    • 2
    • 3
  1. 1.Levine Children’s Hospital, Carolinas Healthcare SystemCharlotteUSA
  2. 2.Hemby Children’s Hospital, Novant HealthCharlotteUSA
  3. 3.Pediatric Surgical AssociatesCharlotteUSA

Personalised recommendations