AAP PaperSingle daily dosing ceftriaxone and metronidazole vs standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomized trial
Section snippets
Methods
Approval was obtained from the Children's Mercy Hospital internal review board (IRB) (IRB no. 04 12-149) before enrolling patients in this study. Patients were subsequently enrolled only after obtaining consent from the patient's legal guardian. The consent forms and consent process were carefully evaluated by the IRB on a continual basis.
Results
From April 2005 to November 2006, 100 patients were enrolled in the study. Two patients were dropped from the study. One was because of surgical failure because of a retained fecalith not removed at the initial operation. The other was because of an urgent family need to transfer the patient to a facility closer to their home before the postoperative course was complete.
Discussion
Triple antibiotic therapy for perforated appendicitis is still common practice in pediatric surgery despite several reports of simpler antibiotic regimens [3], [4], [5]. Monotherapy with newer broad-spectrum agents such as piperacillin/tazobactam for intraabdominal infections has recently been shown to be equally efficacious as traditional triple therapy [3], [4]. Similarly, cefotaxime, a cephalosporin with a similar profile to ceftriaxone, has been shown to be equal to the aforementioned
Acknowledgments
We thank Drs Patricia A. Valusek and Scott J. Keckler, whose efforts made the completion of this study possible.
References (23)
- et al.
A simple and more cost-effective antibiotic regimen for perforated appendicitis
J Pediatr Surg
(2006) - et al.
Does routine nasogastric tube placement after an operation for perforated appendicitis make a difference
J Surg Res
(2007) - et al.
Econotherapeutics
Diagn Microbiol Infect Dis
(1995) - et al.
A randomised, multicentre study of ceftriaxone versus standard therapy in the treatment of lower respiratory tract infections
Int J Antimicrob Agents
(1999) - et al.
Oral neomycin and erythromycin compared with single-dose systemic metronidazole and ceftriaxone prophylaxis in elective colorectal surgery
Am J Surg
(1986) Results of the North American trial of piperacillin/tazobactam compared with clindamycin and gentamicin in the treatment of severe intra-abdominal infections. Investigators of the Piperacillin/Tazobactam Intra-abdominal Infection Study Group
Eur J Surg Suppl
(1994)- et al.
Monotherapy versus multi-drug therapy for the treatment of perforated appendicitis in children
Surg Infect (Larchmt)
(2003) - et al.
Piperacillin/Tazobactam versus cefotaxime plus metronidazole for treatment of children with intra-abdominal infections requiring surgery
Eur J Clin Microbiol Infect Dis
(2001) - et al.
A prospective, randomised comparison of single- vs. multiple-dose antibiotic prophylaxis in penetrating trauma
Chemotherapy
(1999) - et al.
Cost effectiveness of cephalosporin monotherapy and aminoglycoside/ureidopenicillin combination therapy. For the treatment of febrile episodes in neutropenic patients
Pharmacoeconomics
(2000)
Ceftriaxone is twice as cost-effective as standard therapy in biliary tract infection
Hepatogastroenterology
Cited by (129)
Optimizing antibiotic management for patients with acute appendicitis: A quality improvement study
2024, Surgery (United States)Antibiotic resistance is common in the cultures of intraabdominal abscess drainage after appendectomy
2022, Journal of Pediatric SurgeryCitation Excerpt :Approximately 60 000 to 80 000 pediatric appendectomies are performed annually which accounts for a significant proportion of total pediatric general surgical costs [2,4]. Post-operative intra-abdominal abscesses (IAA) are a common complication occurring in approximately 20% of perforated appendicitis patients [5–7]. They are associated with considerable morbidity, leading to increased lengths of stay and healthcare costs [8].
The Utility of Discharge Antibiotics in Pediatric Perforated Appendicitis Without Leukocytosis
2022, Journal of Surgical ResearchAmoxycillin/Clavulanic acid monotherapy in complicated paediatric appendicitis: Good enough?
2022, Journal of Pediatric SurgeryIs Pseudomonas infection associated with worse outcomes in pediatric perforated appendicitis?
2021, Journal of Pediatric Surgery
Presented at the 59th Annual Meeting of the Section on Surgery, American Academy of Pediatrics, San Francisco, CA, October 25-27, 2007.