Prolonged antibiotic treatment does not prevent intra-abdominal abscesses in perforated appendicitis.
BACKGROUND
Children with perforated appendicitis have a relatively high risk of intra-abdominal abscesses. There is no evidence that prolonged antibiotic treatment after surgery reduces intra-abdominal abscess formation. We compared two patient groups with perforated appendicitis with different postoperative antibiotic treatment protocols.


METHODS
We retrospectively reviewed patients younger than age 18 years who underwent appendectomy for perforated appendicitis at two academic hospitals between January 1992 and December 2006. Perforation was diagnosed during surgery and confirmed during histopathological evaluation. Patients in hospital A received 5 days of antibiotics postoperatively, unless decided otherwise on clinical grounds. Patients in hospital B received antibiotics for 5 days, continued until serum C-reactive protein (CRP) was <20 mg/l. Univariate logistic regression analysis was performed on intention-to-treat basis. p < 0.05 was considered significant.


RESULTS
A total of 149 children underwent appendectomy for perforated appendicitis: 68 in hospital A, and 81 in hospital B. As expected, the median (range) use of antibiotics was significantly different: 5 (range, 1-16) and 7 (range, 2-32) days, respectively (p < 0.0001). However, the incidence of postoperative intra-abdominal abscesses was similar (p = 0.95). Regression analysis demonstrated that sex (female) was a risk factor for abscess formation, whereas surgical technique and young age were not.


CONCLUSIONS
Prolonged use of antibiotics after surgery for perforated appendicitis in children based on serum CRP does not reduce postoperative abscess formation.
van Wijck
K
K
Department of Surgery, Maastricht University Medical Center, P.O. Box 616, 6200, Maastricht, MD, The Netherlands. k.vanwijck@ah.unimaas.nl
de Jong
J R
JR
van Heurn
L W E
LW
van der Zee
D C
DC
D018784:Abdominal Abscess / Q000209:etiology / Q000517:prevention & control*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001064:Appendicitis / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
Pediatrics. 2000 Jul;106(1 Pt 1):75-8
10878152
Pediatr Infect Dis J. 1999 Nov;18(11):979-82
10571434
J Pediatr Surg. 2003 Mar;38(3):372-9; discussion 372-9
12632352
Am J Surg. 1996 Dec;172(6A):1S-6S
9003683
Arch Surg. 1996 Mar;131(3):261-4
8611090
Br J Surg. 1994 Jul;81(7):989-91
7922094
J Pediatr Surg. 2000 Feb;35(2):239-44; discussion 244-5
10693673
J Pediatr Surg. 2008 Jun;43(6):981-5
18558169
Arch Surg. 2007 Mar;142(3):236-41; discussion 241
17372047
J Pediatr Surg. 2008 Dec;43(12):2242-5
19040944
J Pediatr Surg. 2008 Feb;43(2):315-9
18280281
Surg Infect (Larchmt). 2008 Feb;9(1):75-83
18363471
J Pediatr Surg. 2007 Jan;42(1):19-23; discussion 23-4
17208535
Pediatr Surg Int. 2004 Dec;20(11-12):838-45
15480707
J Am Coll Surg. 2003 Feb;196(2):212-21
12595049
Int J Surg. 2008 Oct;6(5):371-3
18675602
Am Surg. 2000 Sep;66(9):887-90
10993623
Eur J Surg Suppl. 1996;(576):66-9
8908478
J Pediatr Surg. 1990 Nov;25(11):1113-6
2273422