CAPS Original paperA simple and more cost-effective antibiotic regimen for perforated appendicitis
Section snippets
Methods
A retrospective review of the most recent 250 patients with perforated appendicitis treated at our institution was conducted. This series spanned the past 6 years. The group of patients treated with once-a-day dosing of ceftriaxone and metronidazole (group 1) was compared with the most recent cohort treated with triple antibiotic coverage (group 2). There was a rapid shift in treatment plan from group 2 to group 1 approximately 2 years before data collection; however, there was some overlap
Patients
The 2-drug regimen of ceftriaxone and metronidazole (group 1) was used in 57 patients compared with 193 patients treated with triple antibiotic coverage (group 2). Patient demographics included a mean age of 9.1 ± 0.5 years with a range of 2 to 15 years compared with a mean of age of 7.7 ± 0.3 years with a range 2 to 18 years in group 2. Sex consisted of 64.9% males in group 1 and 67.9% males in group 2.
Presentation
Leukocyte count on admission was 17.8 ± 0.8 × 103 white blood cells in group 1 compared with
Discussion
The impetus for defining a simplified postoperative antibiotic regimen is a strong one. Monotherapy with newer broad-spectrum agents such as piperacillin/tazobactum for intraabdominal infections has recently been demonstrated to be equally efficacious as traditional triple therapy [14], [15]. Similarly, cefotaxime, a cephalosporin with a similar profile to ceftriaxone, has been shown to be equal to the aforementioned monotherapy schedule of piperacillin/tazobactum in children with complicated
Conclusions
Once-a-day dosing with ceftriaxone and Flagyl provides adequate antibiotic coverage for the postoperative management of perforated appendicitis in children. This regimen allows patients to more rapidly defervesce compared with traditional triple antibiotic coverage; moreover, this simple regimen provides substantial advantages for administration and expense.
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Optimizing antibiotic management for patients with acute appendicitis: A quality improvement study
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2019, Journal of Pediatric SurgeryPediatric Appendicitis
2017, Surgical Clinics of North AmericaCitation Excerpt :Both piperacillin/tazobactam and cefoxitin have been shown to be at least as efficacious as the triple-drug regimen and may also decrease length of stay (LOS) and pharmaceutical costs.60 Other studies suggest that metronidazole must be added to a third-generation cephalosporin to cover anaerobic isolates.61,62 The authors’ center begins with a single dose of ceftriaxone sodium (Rocephin) and metronidazole (Flagyl).
Presented at the 37th Annual Meeting of the Canadian Association of Paediatric Surgeons, Quebec, Canada, September 22-25, 2005.