title: Safety of a new protocol decreasing antibiotic utilization after laparoscopic appendectomy for perforated appendicitis in children: A prospective observational study.
abstract: BACKGROUND
  In a previous randomized trial, we found children with perforated appendicitis could be safely discharged prior to completion of a 5 day intravenous antibiotics course. To progress the protocol further, patients who met discharge criteria early were discharged without oral antibiotics if leukocyte counts were normal.
  
  
  METHODS
  Children undergoing laparoscopic appendectomy for perforated appendicitis were prospectively observed after institution of a new antibiotic regimen consisting of daily intravenous dosing ceftriaxone/metronidazole while an inpatient. Patients discharged prior to 5 days were discharged home without oral amoxicillin-clavulanate if no leukocytosis at discharge. Outcomes were compared to the previous protocol of daily intravenous ceftriaxone/metronidazole with completion of a 7-day antibiotic course with amoxicillin-clavulanate of all patients discharged prior to 5 days.
  
  
  RESULTS
  540 patients (270 new protocol, 270 old protocol) were identified. There was no significant difference in patient demographics, admission leukocyte count, time to regular diet, or length of stay. Postoperative abscess occurred in 21.8% in the new protocol compared to 19.3% of the previous (P=0.5). There was a significant decrease in the number of patients discharged home on oral antibiotic therapy (P<0.001).
  
  
  CONCLUSIONS
  Patients meeting discharge criteria with normal leukocyte count prior to completion of 5 days IV antibiotic therapy can be safely discharged home without oral antibiotics after laparoscopic appendectomy for perforated appendicitis.
authors: Department of Surgery, Children's Mercy Hospital, Kansas City, MO.
authors: Amita A
authors: AA
authors: Desai
authors: Department of Surgery, Children's Mercy Hospital, Kansas City, MO.
authors: Hanna
authors: H
authors: Alemayehu
authors: Department of Surgery, Children's Mercy Hospital, Kansas City, MO.
authors: George W
authors: GW
authors: Holcomb
authors: Department of Surgery, Children's Mercy Hospital, Kansas City, MO. Electronic address: sspeter@cmh.edu.
authors: Shawn D
authors: SD
authors: St Peter
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy / Q000379:methods; D001064:Appendicitis / Q000188:drug therapy* / Q000601:surgery; D002443:Ceftriaxone / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D010535:Laparoscopy; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D010351:Patient Discharge; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D019980:Amoxicillin-Potassium Clavulanate Combination; D002443:Ceftriaxone
keywords: Antibiotic; Appendicitis; Children; Perforated