title: Ertapenem versus standard triple antibiotic therapy for the treatment of perforated appendicitis in pediatric patients: a prospective randomized trial.
abstract: BACKGROUND
  The primary objective of this study was to compare triple therapy with ertapenem treatments in pediatric patients with perforated appendicitis, especially in terms of postoperative infectious complications. The secondary objective of this study was to assess the relative impact of therapy with ertapenem and triple antibiotic regimen on the emergence of resistant bacteria in bowel flora in the patients.
  
  
  METHODS
  Children aged 3 months to 17 years with perforated appendicitis were randomized 1:1 to receive ertapenem or triple therapy. Serial rectal cultures were obtained from participants enrolled in the study, allowing assessment of the relative impact of therapy with ertapenem and triple therapy on bowel colonization by resistant bacteria.
  
  
  RESULTS
  In this study, 107 patients were included. No difference existed in time to full oral intake and regular diet, the length of antibiotic therapy, the length of the postoperative hospitalization, or the length of hospital stay between the two groups. Patients in the triple-therapy group were more likely to suffer from a postoperative infectious complication than those in the ertapenem group (6/54 vs. 2/53, p > 0.05). Bowel colonization with resistant organisms at the end of therapy in the triple-therapy group was significantly different than in the ertapenem group (35.2 vs. 11.3%, p < 0.05).
  
  
  CONCLUSIONS
  Bowel colonization with resistant bacteria was less likely to occur after ertapenem treatment than triple therapy. The results of this trial suggest that ertapenem may be a useful option that could eliminate the need for combination and/or multidosed antibiotic regimens for the empiric treatment of perforated appendicitis in children.
authors: Division of Pediatric Infectious Diseases, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
authors: Nazan
authors: N
authors: Dalgic
authors: Division of Pediatric Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
authors: Cetin Ali
authors: CA
authors: Karadag
authors: Division of Microbiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
authors: Banu
authors: B
authors: Bayraktar
authors: Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Turkey.
authors: Mesut
authors: M
authors: Sancar
authors: Division of Pediatric Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
authors: Ozlem
authors: O
authors: Kara
authors: Division of Microbiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
authors: Suleyman
authors: S
authors: Pelit
authors: Division of Pediatric Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
authors: Suleyman
authors: S
authors: Celebi
authors: Division of Pediatric Infectious Diseases, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
authors: Ihsan
authors: I
authors: Kafadar
authors: Division of Pediatric Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
authors: Ali Ihsan
authors: AI
authors: Dokucu
mesh_terms: D000293:Adolescent; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy / Q000009:adverse effects*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D000077727:Ertapenem; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007422:Intestines / Q000382:microbiology; D008297:Male; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D047090:beta-Lactams / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D047090:beta-Lactams; D002981:Clindamycin; D000667:Ampicillin; D000077727:Ertapenem