title: Pediatric appendicitis and need for antibiotics at time of discharge: Does route of administration matter?
abstract: BACKGROUND
  Following complicated appendicitis, there are limited data available to guide the surgeon regarding antibiotic selection, specifically in regards to route of administration. We hypothesized that among children with appendicitis who are discharged home with antibiotic therapy, the post-discharge readmission and complication rates do not differ between those children who receive IV antibiotics and those who receive PO antibiotics.
  
  
  METHODS
  We performed a retrospective review of all children discharged home on antibiotics following appendectomy at a single institution between 11/10-10/14. We compared outcomes including ED and hospital readmission rates, and development of postoperative complications, between those children who were discharged on IV antibiotics and those discharged on PO antibiotics.
  
  
  RESULTS
  325 children were discharged with antibiotics following appendectomy (n=291 PO antibiotics group; n=34 IV group). On both univariate and multivariate analysis, rate of each complication did not differ between the two groups including inpatient readmission (5% PO vs. 6% IV; p=0.8), ED readmission (10% vs. 11%; p=0.8), postdischarge complications related to the operation (10% vs. 15%; p=0.4), or abscess development post-discharge (4% vs. 3%; p=1).
  
  
  CONCLUSIONS
  Among children with complicated appendicitis who are discharged home with ongoing antibiotic therapy, our data demonstrate no differences in outcomes between those children who receive IV and PO antibiotics. Further data, collected in a prospective fashion, are needed to clarify the role of IV and PO antibiotics among children with perforated appendicitis.
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: Shannon.acker@ucdenver.edu.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Acker
authors.affiliation: Department of Pharmacy, Children's Hospital Colorado, Aurora, CO, USA. Electronic address: Amanda.hurst@childrenscolorado.org.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Hurst
authors.affiliation: Department of Surgery, Denver Health Medical Center, Denver, CO, USA. Electronic address: denis.bensard@dhha.org.
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: anna.schubert@ucdenver.edu.
authors.forename: Anna
authors.initials: A
authors.lastname: Schubert
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: lindel.dewberry@ucdenver.edu.
authors.forename: Lindel
authors.initials: L
authors.lastname: Dewberry
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: Danielle.gonzales@ucdenver.edu.
authors.forename: Danielle
authors.initials: D
authors.lastname: Gonzales
authors.affiliation: Division of Pediatric Infectious Disease, Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA. Electronic address: sarah.parker@childrenscolorado.org.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Parker
authors.affiliation: Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA. Electronic address: suhong.tong@childrenscolorado.org.
authors.forename: Suhong
authors.initials: S
authors.lastname: Tong
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA. Electronic address: david.partrick@childrenscolorado.org.
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
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; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Appendicitis; Children; IV antibiotics; PO antibiotics