A complete course of intravenous antibiotics vs a combination of intravenous and oral antibiotics for perforated appendicitis in children: a prospective, randomized trial.
BACKGROUND
In a previous prospective randomized trial, we found a once-a-day regimen of ceftriaxone and metronidazole to be an efficient, cost-effective treatment for children with perforated appendicitis. In this study, we evaluated the safety of discharging patients to complete an oral course of antibiotics.


METHODS
Children found to have perforated appendicitis at the time of laparoscopic appendectomy were enrolled in the study. Perforation was defined as a hole in the appendix or fecalith in the abdomen. Patients were randomized to antibiotic treatment with either once daily dosing of ceftriaxone and metronidazole for a minimum of 5 days (intravenous [IV] arm) or discharge to home on oral amoxicillin/clavulanate when tolerating a regular diet (IV/PO arm) to complete 7 days.


RESULTS
One hundred two patients underwent laparoscopic appendectomy for perforated appendicitis. On presentation, there were no differences in age, weight, sex distribution, days of symptoms, maximum temperature, or leukocyte count between the 2 groups. There was no difference in the postoperative abscess rate between the two treatment groups. Discharge was possible before day 5 in 42% of the patients in the IV/PO arm.


CONCLUSIONS
When patients are able to tolerate a regular diet, completing the course of antibiotics orally decreases hospitalization with no effect on the risk of postoperative abscess formation.
Fraser
Jason D
JD
Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA.
Aguayo
Pablo
P
Leys
Charles M
CM
Keckler
Scott J
SJ
Newland
Jason G
JG
Sharp
Susan W
SW
Murphy
John P
JP
Snyder
Charles L
CL
Sharp
Ronald J
RJ
Andrews
Walter S
WS
Holcomb
George W
GW
Ostlie
Daniel J
DJ
St Peter
Shawn D
SD
D000284:Administration, Oral; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001062:Appendectomy / Q000379:methods; D001064:Appendicitis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D002443:Ceftriaxone / Q000008:administration & dosage*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D010535:Laparoscopy; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012422:Rupture, Spontaneous; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D008795:Metronidazole; D002443:Ceftriaxone; D000658:Amoxicillin