title: Oral antibiotics in the management of perforated appendicitis in children.
abstract: After appendectomy for perforated appendicitis children have traditionally been managed with intravenous broad-spectrum antibiotics for 5 to 10 days and then until fever and leukocytosis have resolved. We prospectively evaluated a protocol of hospital discharge on oral antibiotics when oral intake is tolerated-regardless of fever or leukocytosis-in a consecutive series of 80 children between one and 15 years of age who underwent appendectomy (38 open and 42 laparoscopic) for perforated appendicitis. At discharge subjects began a 7-day course of oral trimethoprim/sulfamethoxazole and metronidazole. Patients were discharged between 2 and 18 days postoperatively (mean 5.3 days). Sixty-six were discharged on oral antibiotics, and 28 of these had persistent fever or leukocytosis. Two patients (2.5%) developed postoperative intra-abdominal abscesses while inpatients. Wound infections developed in seven patients (8.8%) four of whom were on intravenous antibiotics. Among the 66 children who were discharged on oral antibiotics without having had an inpatient infectious complication there were three wound infections (4.4%). None of these patients had a fever or leukocytosis at discharge. We conclude that after appendectomy for perforated appendicitis children may be safely discharged home on oral antibiotics when enteral intake is tolerated regardless of fever or leukocytosis.
authors.affiliation: Division of Pediatric Surgery, Loma Linda University School of Medicine and Children's Hospital, Loma Linda, California 92354, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Gollin
authors.forename: Aaron
authors.initials: A
authors.lastname: Abarbanell
authors.forename: Donald
authors.initials: D
authors.lastname: Moores
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications* / Q000188:drug therapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003663:Decision Trees; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D004750:Enteral Nutrition; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000209:etiology* / Q000382:microbiology; D007964:Leukocytosis / Q000209:etiology; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D010351:Patient Discharge; D011446:Prospective Studies; D012422:Rupture, Spontaneous; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D008795:Metronidazole; D015662:Trimethoprim, Sulfamethoxazole Drug Combination