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Once-Daily Ceftriaxone Plus Metronidazole Versus Ertapenem and/or Cefoxitin for Pediatric Appendicitis

Amanda L Hurst1, Daniel Olson2,3, Stig Somme2,4

  • 1Department of Pharmacy.

Journal of the Pediatric Infectious Diseases Society
|December 26, 2015
PubMed

Insights

Ceftriaxone plus metronidazole (CTX plus MTZ) is an effective and cost-saving antibiotic regimen for pediatric appendicitis. This simplified treatment offers faster recovery and significant cost reductions compared to older methods.

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Pharmacoeconomics

Background:

  • Appendicitis is a common pediatric surgical emergency requiring broad-spectrum antibiotics.
  • Evaluating cost-effectiveness of simplified antibiotic regimens is crucial for pediatric care.
  • Comparing historical antibiotic protocols with a ceftriaxone and metronidazole (CTX plus MTZ) regimen for appendicitis.

Observation:

  • A retrospective review analyzed 841 pediatric appendicitis cases (nonperforated, perforated, abscessed).
  • Outcomes measured included length of stay, time to afebrile, time to full feeds, and complication rates.
  • Antibiotic costs were compared between historical (cefoxitin/ertapenem) and CTX plus MTZ regimens.

Findings:

  • The CTX plus MTZ group demonstrated a significantly shorter time to afebrile status (P < .001).
  • No significant differences were observed in length of stay or postoperative abscess/infection rates between treatment groups.
  • Total antibiotic cost savings exceeded $110,000 with the CTX plus MTZ regimen.

Implications:

  • Ceftriaxone plus metronidazole (CTX plus MTZ) is an effective and safe alternative for treating pediatric appendicitis.
  • This regimen offers improved patient recovery metrics (time to afebrile) and substantial cost savings.
  • Streamlined antibiotic protocols like CTX plus MTZ can optimize resource allocation in pediatric surgical care.
Abstract

Keywords:
antibioticsantimicrobial stewardshipappendicitispediatric

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