title: Once-Daily Ceftriaxone Plus Metronidazole Versus Ertapenem and/or Cefoxitin for Pediatric Appendicitis.
abstract: BACKGROUND
  Appendicitis is a common surgical emergency in pediatric patients, and broad-spectrum antibiotic therapy is warranted in their care. A simplified once-daily regimen of ceftriaxone and metronidazole (CTX plus MTZ) is cost effective in perforated patients. The goal of this evaluation is to compare a historic regimen of cefoxitin (CFX) in nonperforated cases and ertapenem (ERT) in perforated and abscessed cases with CTX plus MTZ for all cases in terms of efficacy and cost.
  
  
  METHODS
  A retrospective review compared outcomes of nonperforated, perforated, and abscessed cases who received the historic regimen or CTX plus MTZ. Length of stay, time to afebrile, time to full feeds, postoperative abscess, and wound infection rates, inpatient readmissions, and antibiotic costs were evaluated.
  
  
  RESULTS
  There were a total of 841 cases reviewed (494 nonperforated, 247 perforated, and 100 abscessed). Overall, the CTX plus MTZ group had a shorter time to afebrile (P < .001). Treatment groups did not differ in length of stay. Postoperative abscess rates were similar between groups (4.1% vs 3.3%, not significant). Other postoperative complications were similar between groups. Total antibiotic cost savings were over $110 000 during the study period (from November 2010 to June 2013).
  
  
  CONCLUSIONS
  Both CFX and/or ERT and CTX plus MTZ result in low abscess and complication rates, suggesting both are effective strategies. Treatment with CTX plus MTZ results in a shorter time to afebrile, while also providing significant antibiotic cost savings. Ceftriaxone plus MTZ is a streamlined, cost-effective regimen in the treatment of nonperforated, perforated, and abscessed appendicitis.
authors.affiliation: Department of Pharmacy.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Hurst
authors.affiliation: Department of Pediatrics.|Division of Pediatric Infectious Diseases.
authors.forename: Daniel
authors.initials: D
authors.lastname: Olson
authors.affiliation: Department of Pediatrics.|Division of General, Thoracic, and Fetal Pediatric Surgery.
authors.forename: Stig
authors.initials: S
authors.lastname: Somme
authors.affiliation: Department of Pharmacy.
authors.forename: Jason
authors.initials: J
authors.lastname: Child
authors.affiliation: Department of Pediatrics.
authors.forename: Laura
authors.initials: L
authors.lastname: Pyle
authors.affiliation: Division of Clinical Informatics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Daksha
authors.initials: D
authors.lastname: Ranade
authors.affiliation: Department of Infection Control.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Stamatoiu
authors.affiliation: Department of Pediatrics.|Division of General, Thoracic, and Fetal Pediatric Surgery.
authors.forename: Timothy
authors.initials: T
authors.lastname: Crombleholme
authors.affiliation: Department of Pediatrics.|Division of Pediatric Infectious Diseases.|Department of Infection Control.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Parker
mesh_terms: D018784:Abdominal Abscess / Q000188:drug therapy / Q000191:economics; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000188:drug therapy* / Q000191:economics; D002440:Cefoxitin / Q000191:economics / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis / Q000191:economics; D004334:Drug Administration Schedule; D057915:Drug Substitution; D004359:Drug Therapy, Combination / Q000191:economics; D000077727:Ertapenem; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D008795:Metronidazole / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult; D047090:beta-Lactams / Q000191:economics / Q000627:therapeutic use*
chemical_list: D047090:beta-Lactams; D008795:Metronidazole; D002440:Cefoxitin; D002443:Ceftriaxone; D000077727:Ertapenem
keywords: antibiotics; antimicrobial stewardship; appendicitis; pediatric