Seattle, WA—While guidelines recommend either narrow- or extended-spectrum antibiotics for treatment of complicated pediatric appendicitis treated after surgery, the question remains whether narrow-spectrum antibiotics are sufficient or if extended-spectrum formulations are always necessary.
A study published recently in the journal Pediatrics proposes some answers.
A team led by researchers from the University of Washington and Seattle Children’s Hospital Research Institute performed a retrospective cohort study of children aged 3 to 18 years discharged between 2011 and 2013 from 23 freestanding children’s hospitals with an appendicitis diagnosis and appendectomy performed. Of 24,984 patients, 70.7% had uncomplicated appendicitis and 29.3% had complicated appendicitis, which was was defined as involving a postoperative length of stay of 3 days or longer, placement of a central venous catheter, major or severe illness classification, or admission to an intensive care unit (ICU).
Patients received systemic extended-spectrum antibiotics piperacillin plus or minus tazobactam, ticarcillin plus or minus clavulanate, ceftazidime, cefepime, or a carbapenem on the day of appendectomy or the day after. The primary outcome was 30-day readmission for wound infection or repeat abdominal surgery.
Results indicate that 2.7% of patients experienced the primary outcome—1.1% among uncomplicated cases and 6.4% among complicated cases. The study reports that extended-spectrum antibiotic exposure was significantly associated with the primary outcome in complicated appendicitis, adjusted odds ratio, 1.43, but not uncomplicated, adjusted odds ratio, 1.32.
“Extended-spectrum antibiotics seem to offer no advantage over narrower-spectrum agents for children with surgically managed acute uncomplicated or complicated appendicitis,” study authors conclude.
A study earlier this year also argues that children with uncomplicated appendicitis might not have been good candidates for surgical treatment in the first place.
Researchers at Nationwide Children’s Hospital in Columbus, Ohio found that three out of four children with uncomplicated appendicitis had been successfully treated with antibiotics alone at one year follow-up. The report, published in JAMA Surgery, notes that, in comparison with urgent appendectomy, nonoperative management was associated with less recovery time, lower health costs, and no difference in the rate of complications at 1 year.
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