title: Early transition to oral antibiotics for treatment of perforated appendicitis in pediatric patients: Confirmation of the safety and efficacy of a growing national trend.
abstract: OBJECTIVE
  We performed a quality improvement initiative to monitor the change in protocol from purely intravenous therapy for perforated appendicitis to oral antibiotics at discharge once patients could tolerate eating.
  
  
  METHODS
  Standardized prospective data were gathered on all children with perforated appendicitis treated under the new oral protocol from January 1 to December 31, 2014. Retrospective data through chart review were gathered on all children treated for perforated appendicitis during 2013. We compared demographics, clinical parameters, and hospital charges.
  
  
  RESULTS
  Comparing 115 patients in 2013 and 144 in 2014, demographics and clinical characteristics were similar. In 2014, 95% of patients were discharged on oral therapy. Compared to the intravenous group, the enteric group had statistically lower rates of repeat ultrasound imaging (49.6% vs 35.1%) and PICC placement (98.3% vs 9.1%) and similar rates of intraabdominal abscess (20.9% vs 16.0%) and antibiotic change (26.1% vs 22.2%). In 2014, 55% of patients were discharged by postoperative day 5, compared to 33% in 2013. Total antibiotic days and readmission rate were similar, while hospital charges decreased by half.
  
  
  CONCLUSIONS
  Our results reaffirm that transition to oral antibiotics is safe, effective, and cost-efficient in treatment of perforated appendicitis in the child.
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL.
authors.forename: Tara J
authors.initials: TJ
authors.lastname: Loux
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL.
authors.forename: Gavin A
authors.initials: GA
authors.lastname: Falk
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL. Electronic address: Cathy.Burnweit@mch.com.
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Burnweit
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ramos
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL.
authors.forename: Colin
authors.initials: C
authors.lastname: Knight
authors.affiliation: Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL.
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Malvezzi
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001062:Appendectomy; D001064:Appendicitis / Q000188:drug therapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D010351:Patient Discharge; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Oral antibiotic therapy; Pediatric perforated appendicitis