title: Extended- Versus Narrower-Spectrum Antibiotics for Appendicitis.
abstract: Appendicitis guidelines recommend either narrower- or extended-spectrum antibiotics for treatment of complicated appendicitis. The goal of this study was to compare the effectiveness of extended-spectrum versus narrower-spectrum antibiotics for children with appendicitis.
  
  
  
  We performed a retrospective cohort study of children aged 3 to 18 years discharged between 2011 and 2013 from 23 freestanding children's hospitals with an appendicitis diagnosis and appendectomy performed. Subjects were classified as having complicated appendicitis if they had a postoperative length of stay ≥3 days, a central venous catheter placed, major or severe illness classification, or ICU admission. The exposure of interest was receipt of systemic extended-spectrum antibiotics (piperacillin ± tazobactam, ticarcillin ± clavulanate, ceftazidime, cefepime, or a carbapenem) on the day of appendectomy or the day after. The primary outcome was 30-day readmission for wound infection or repeat abdominal surgery. Multivariable logistic regression, propensity score weighting, and subgroup analyses were used to control for confounding by indication.
  
  
  
  Of 24 984 patients, 17 654 (70.7%) had uncomplicated appendicitis and 7330 (29.3%) had complicated appendicitis. Overall, 664 (2.7%) patients experienced the primary outcome, 1.1% among uncomplicated cases and 6.4% among complicated cases (P < .001). Extended-spectrum antibiotic exposure was significantly associated with the primary outcome in complicated (adjusted odds ratio, 1.43 [95% confidence interval, 1.06 to 1.93]), but not uncomplicated, (adjusted odds ratio, 1.32 [95% confidence interval, 0.88 to 1.98]) appendicitis. These odds ratios remained consistent across additional analyses.
  
  
  
  Extended-spectrum antibiotics seem to offer no advantage over narrower-spectrum agents for children with surgically managed acute uncomplicated or complicated appendicitis.
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, Washington; Center for Clinical and Translational Research, and matthew.kronman@seattlechildrens.org.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Kronman
authors.affiliation: Center for Clinical and Translational Research, and.
authors.forename: Assaf P
authors.initials: AP
authors.lastname: Oron
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Rachael K
authors.initials: RK
authors.lastname: Ross
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah;
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.affiliation: Division of Infectious Diseases, Children's Mercy Hospitals and Clinics, Kansas City, Missouri;
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
authors.affiliation: Department of Pediatric Surgery, University of Washington, Seattle, Washington; and.
authors.forename: Adam
authors.initials: A
authors.lastname: Goldin
authors.affiliation: Department of Pediatric Surgery, Harvard Medical School, Boston, Massachusetts.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, Washington; Center for Global Infectious Diseases Research, Seattle Children's Hospital Research Institute, Seattle, Washington;
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Weissman
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, Washington; Center for Clinical and Translational Research, and.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Zerr
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000145:classification / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D001424:Bacterial Infections / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents