title: Benefits of an abridged antibiotic protocol for treatment of gangrenous appendicitis.
abstract: BACKGROUND
  We previously reported a validated, objective definition of gangrenous, nonperforated appendicitis. In this study, we compared a cohort of children with gangrenous appendicitis treated with abridged antibiotics (AA) to another treated with prolonged antibiotics (PA).
  
  
  METHODS
  In 2012, our service changed its standard of care for gangrenous appendicitis from PA to AA. In PA, patients received postoperative triple antibiotics until ileus resolved, they were afebrile (<37.5°C) for 24hours, and achieved a normal WBC count. In AA, patients received two doses of postoperative triple antibiotics. A PA cohort during a 12-month period (February 2010-January 2011) was compared to an AA cohort during another 12-month period (April 2012-March 2013).
  
  
  RESULTS
  Twenty patients were treated with AA and 38 patients with PA. AA patients had a significantly shorter overall length of stay (2.1±1.58 vs. 3.18±1.09days, p=0.003), as well as a significantly shorter postoperative stay (1.85±1.42 vs. 2.95±1.14days, p=0.002). There were no differences between the AA and PA cohorts in wound infections (0%), intraabdominal infections (0%), or appendicitis-related readmissions (0%).
  
  
  CONCLUSIONS
  Abridged postoperative antibiotics for gangrenous appendicitis significantly shorten hospital stay without increasing complications.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Layla
authors.initials: L
authors.lastname: Shbat
authors.affiliation: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: Sherif.Emil@McGill.ca.
authors.forename: Sherif
authors.initials: S
authors.lastname: Emil
authors.affiliation: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Sherif
authors.initials: S
authors.lastname: Elkady
authors.affiliation: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Baird
authors.affiliation: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Jean-Martin
authors.initials: JM
authors.lastname: Laberge
authors.affiliation: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Pramod
authors.initials: P
authors.lastname: Puligandla
authors.affiliation: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Shaw
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001062:Appendectomy; D001064:Appendicitis / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D001065:Appendix / Q000473:pathology; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D005734:Gangrene / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D011182:Postoperative Care / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Appendicitis; Gangrenous; Outcomes; Pediatric