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Safety of a new protocol decreasing antibiotic utilization after laparoscopic appendectomy for perforated
Amita A Desai1, Hanna Alemayehu1, George W Holcomb1
1Department of Surgery, Children's Mercy Hospital, Kansas City, MO.
Insights
Children with perforated appendicitis can safely skip oral antibiotics after surgery if their white blood cell count is normal. This reduces antibiotic exposure and streamlines recovery for pediatric patients.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Clinical Trials
Background:
- Previous trials demonstrated safe early discharge for children with perforated appendicitis before completing 5-day IV antibiotics.
- Further protocol refinement aimed to eliminate oral antibiotics for select early-discharge patients.
Purpose of the Study:
- To evaluate the safety and outcomes of discharging children with perforated appendicitis without oral antibiotics post-laparoscopic appendectomy, provided they meet discharge criteria and have normal leukocyte counts.
Main Methods:
- A prospective observational study compared a new protocol (daily IV ceftriaxone/metronidazole, no oral antibiotics if leukocyte count normal at discharge) with a previous protocol (7-day total antibiotic course).
- 540 pediatric patients undergoing laparoscopic appendectomy for perforated appendicitis were analyzed.
Main Results:
- No significant differences were observed in patient demographics, admission leukocyte count, time to diet, or length of stay between the two groups.
- Postoperative abscess rates were similar (21.8% new vs. 19.3% old protocol, P=0.5).
- A significant reduction in patients discharged on oral antibiotics was achieved with the new protocol (P<0.001).
Conclusions:
- Children meeting discharge criteria with a normal leukocyte count can be safely discharged without oral antibiotics following laparoscopic appendectomy for perforated appendicitis.
- This approach effectively reduces unnecessary antibiotic exposure in pediatric surgical patients.
Introduction:
In a previous randomized trial, we found children with perforated appendicitis could be safely discharged prior to completion of a 5 day intravenous antibiotics course. To progress the protocol further, patients who met discharge criteria early were discharged without oral antibiotics if leukocyte counts were normal.
Methods:
Children undergoing laparoscopic appendectomy for perforated appendicitis were prospectively observed after institution of a new antibiotic regimen consisting of daily intravenous dosing ceftriaxone/metronidazole while an inpatient. Patients discharged prior to 5 days were discharged home without oral amoxicillin-clavulanate if no leukocytosis at discharge. Outcomes were compared to the previous protocol of daily intravenous ceftriaxone/metronidazole with completion of a 7-day antibiotic course with amoxicillin-clavulanate of all patients discharged prior to 5 days.
Results:
540 patients (270 new protocol, 270 old protocol) were identified. There was no significant difference in patient demographics, admission leukocyte count, time to regular diet, or length of stay. Postoperative abscess occurred in 21.8% in the new protocol compared to 19.3% of the previous (P=0.5). There was a significant decrease in the number of patients discharged home on oral antibiotic therapy (P<0.001).
Conclusions:
Patients meeting discharge criteria with normal leukocyte count prior to completion of 5 days IV antibiotic therapy can be safely discharged home without oral antibiotics after laparoscopic appendectomy for perforated appendicitis.
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