Early Transition to Oral Antibiotics for Treatment of Perforated Appendicitis in Pediatric Patients: Confirmation of the Safety and Efficacy of a Growing National Trend

• Published in: Journal of pediatric surgery Vol. 51; no. 6; pp. 903 - 907
• Main Authors: Loux, Tara J, Falk, Gavin A, Burnweit, Cathy A, Ramos, Carmen, Knight, Colin, Malvezzi, Leopoldo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2016
• Subjects: Administration, Oral; Adolescent; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Appendectomy; Appendicitis - drug therapy; Appendicitis - surgery; Child; Child, Preschool; Clinical Protocols; Combined Modality Therapy; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Injections, Intravenous; Male; Oral antibiotic therapy; Patient Discharge; Pediatric perforated appendicitis; Pediatrics; Postoperative Care - methods; Prospective Studies; Retrospective Studies; Surgery; Treatment Outcome; oral antibiotic therapy; pediatric perforated appendicitis; Pediatric perforated appendicitis; Oral antibiotic therapy
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2016.02.057

Abstract Purpose We performed a quality improvement initiative to monitor the change in protocol from purely intravenous therapy for perforated appendicitis to oral antibiotics at discharge once patients could tolerate eating. Methods Standardized prospective data were gathered on all children with perforated appendicitis treated under the new oral protocol from January 1 – December 31, 2014. Retrospective data through chart review were gathered on all children treated for perforated appendicitis during 2013. We compared demographics, clinical parameters, and hospital charges. Results Comparing 115 patients in 2013 and 144 in 2014, demographics and clinical characteristics were similar. In 2014, 95% of patients were discharged on oral therapy. Compared to the intravenous group, the enteric group had statistically lower rates of repeat ultrasound imaging (49.6% vs 35.1%) and PICC placement (98.3% vs 9.1%) and similar rates of intra-abdominal abscess (20.9 % vs 16.0 %) and antibiotic change (26.1 % vs 22.2%). In 2014, 55% of patients were discharged by post-operative day 5, compared to 33% in 2013. Total antibiotic days and readmission rate were similar, while hospital charges decreased by half. Conclusion Our results reaffirm that transition to oral antibiotics is safe, effective, and cost-efficient in treatment of perforated appendicitis in the child.