A simple and more cost-effective antibiotic regimen for perforated appendicitis

Area of Science:

• Pediatric Surgery
• Infectious Diseases
• Pharmacology

Background:

• Appendicitis is a common pediatric surgical emergency.
• Perforated appendicitis necessitates intravenous antibiotic treatment post-surgery.
• The standard three-drug regimen (ampicillin, gentamicin, clindamycin) presents dosing challenges.

Purpose of the Study:

• To evaluate a simplified two-drug antibiotic regimen (ceftriaxone and Flagyl) for treating perforated appendicitis in children.
• To compare the efficacy and cost-effectiveness of the new regimen against the traditional three-drug regimen.

Main Methods:

• Retrospective review of 250 pediatric patients with perforated appendicitis.
• Comparison of patients receiving a two-drug regimen versus a historical cohort on triple antibiotic coverage.
• Analysis of postoperative temperature, abscess rates, hospitalization duration, antibiotic treatment length, and medication charges.

Main Results:

• The two-drug regimen group showed significantly faster defervescence from postoperative day 1 (P < .001).
• Abscess rates were similar between groups (8.8% vs 14.2%, P = .37).
• Mean length of stay was shorter (6.8 vs 7.8 days, P = .03) with substantial cost savings ($1186.05 over 5 days).

Conclusions:

• Once-daily ceftriaxone and Flagyl effectively manage postoperative perforated appendicitis in children.
• This simplified regimen facilitates quicker patient recovery and offers significant advantages in administration and cost.
• The two-drug regimen is a viable, cost-effective alternative to traditional triple antibiotic therapy.