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Aminoglycoside-based triple-antibiotic therapy versus monotherapy for children with ruptured appendicitis

Adam B Goldin1, Robert S Sawin, Michelle M Garrison

  • 1Department of Pediatric General and Thoracic Surgery, Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA. adam.goldin@seattlechildrens.org

Pediatrics
|May 3, 2007
PubMed

Insights

Single-agent antibiotic therapy for perforated appendicitis is increasingly used and as effective as triple therapy. Monotherapy may reduce hospital stay and charges, offering a potentially better treatment option for pediatric patients.

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Pharmacology

Background:

  • Perforated appendicitis in children and adolescents traditionally treated with triple antibiotic therapy.
  • Emerging evidence suggests single-agent antibiotic therapy may be a viable alternative.

Purpose of the Study:

  • To compare triple therapy versus monotherapy for perforated appendicitis in pediatric patients.
  • To identify trends in antibiotic regimen selection within children's hospitals.
  • To assess the association of antibiotic regimens with patient outcomes.

Main Methods:

  • Retrospective cohort study using the Pediatric Health Information System database (32 US children's hospitals).
  • Analysis of antibiotic usage trends and outcomes (readmissions, length of stay, charges) for perforated appendicitis (March 1999–September 2004).
  • Pairwise regression analyses comparing monotherapy regimens with triple therapy.

Main Results:

  • 58% of 8545 patients received triple therapy; a transition from 69% to 52% monotherapy use was observed over 6 years.
  • No significant difference in 30-day readmission rates, except for decreased odds with ceftriaxone.
  • Piperacillin/tazobactam and cefoxitin monotherapy associated with significantly reduced length of stay and hospital charges.

Conclusions:

  • Single-agent antibiotic therapy for perforated appendicitis is increasingly adopted.
  • Monotherapy demonstrates comparable efficacy to traditional triple therapy.
  • Monotherapy may lead to reduced length of stay, pharmacy, and overall hospital charges.
Abstract

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