Postoperative antibiotic therapy for children with perforated appendicitis: long course of intravenous antibiotics versus early conversion to an oral regimen.
BACKGROUND
Although treatment for nonperforated acute appendicitis is usually straightforward, the optimal treatment of patients with perforated appendicitis remains controversial.


METHODS
Our institution performed a 2.5-year retrospective review of outcomes for postoperative treatment of perforated appendicitis. Patients were treated with either short-term intravenous (IV) antibiotic therapy and conversion to PO antibiotics (PO group) or long-term antibiotic therapy by way of a peripherally inserted central venous catheter (IV group).


RESULTS
One-hundred forty-nine patients with a diagnosis of perforated appendicitis were reviewed. There were 47 patients in the PO group and 102 patients in the IV group. In the IV group, there were 2 intra-abdominal abscesses (2%) requiring readmission; there were also 2 intra-abdominal abscesses in the PO group (4.2%). Outpatient conversion to PO antibiotics resulted in an average savings of approximately $4,000/patient.


CONCLUSIONS
Inpatient IV antibiotic therapy followed by outpatient conversion to PO antibiotics is a safe and cost-effective treatment of perforated appendicitis.
Adibe
Obinna O
OO
Department of General, Thoracic, and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Barnaby
Karen
K
Dobies
Jennifer
J
Comerford
Monica
M
Drill
Antoinette
A
Walker
Natalie
N
Mattei
Peter
P
D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001062:Appendectomy / Q000379:methods; D001064:Appendicitis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents