Convalescent phase outpatient parenteral antiinfective therapy for children with complicated appendicitis.
BACKGROUND
Children with a perforated or gangrenous appendix become clinically stable after medical and/or surgical therapy but often remain in the hospital solely to complete parenteral antibiotic therapy. This prospective study investigates the outcomes when children who meet specified criteria are discharged to complete parenteral antibiotic therapy at home.


METHODS
Children age 1 to 17 years with appendicitis complicated by generalized peritonitis or intraabdominal abscess were eligible to participate. Subjects whose fever was decreasing, who were able to tolerate oral liquids and for whom further parenteral antibiotic therapy was deemed necessary were discharged from the hospital to receive outpatient parenteral antiinfective therapy (OPAT) with meropenem. Therapy was administered by a family member and supervised by home care nurses. Study personnel visited the home daily to collect data on adverse events, compliance and resource utilization. Pa tients served as their own controls in models of reduced hospitalization and net cost savings.


RESULTS
Discharged on average on the fourth postoperative day, 87 children received 4.5 +/- 2.1 days of OPAT. Six (7%) children were subsequently readmitted for complications including bowel obstruction (4 children), intraabdominal abscess (1 child) and pleural effusion (1 child). Another child developed a viral syndrome during OPAT. All other patients recovered uneventfully. Six (7%) children discontinued meropenem prematurely because of rash (4 patients) or diarrhea (2 patients). According to models in which each day of OPAT replaced a day of inpatient care, discharge to OPAT reduced hospitalization by 42 +/- 15% and saved a median of $2908 (10th to 90th percentile range, $1,077 to $4,707) per patient.


CONCLUSIONS
Convalescent phase OPAT is a cost-effective alternative to continued hospitalization for children with complicated appendicitis who are clinically stable yet require further parenteral antibiotic therapy.
Bradley
J S
JS
Division of Infectious Diseases, Children's Hospital, San Diego, CA, USA. jbradley@chsd.org
Behrendt
C E
CE
Arrieta
A C
AC
Harrison
C J
CJ
Loeffler
A M
AM
Iaconis
J P
JP
Wald
E R
ER
D018784:Abdominal Abscess / Q000188:drug therapy*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001064:Appendicitis / Q000150:complications* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003289:Convalescence / Q000191:economics; D018718:Home Infusion Therapy / Q000191:economics* / Q000592:standards; D006701:Home Nursing / Q000191:economics* / Q000592:standards; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D000077731:Meropenem; D017059:Models, Econometric; D010351:Patient Discharge / Q000191:economics*; D010538:Peritonitis / Q000188:drug therapy*; D011446:Prospective Studies; D013845:Thienamycins / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077731:Meropenem