Once Daily Dosing of Ceftriaxone and Metronidazole in Children With Perforated Appendicitis

Area of Science:

• Pediatric Surgery
• Infectious Diseases
• Clinical Pharmacy

Background:

• Perforated appendicitis in children often requires surgical intervention and postoperative antibiotic therapy.
• The choice of antibiotic regimen can influence patient outcomes, including infection rates and hospital length of stay.
• Understanding the comparative efficacy and safety of different antibiotic protocols is crucial for optimizing pediatric care.

Purpose of the Study:

• To compare the hospital length of stay and infectious complication rates in pediatric patients with perforated appendicitis.
• To evaluate outcomes based on the specific postoperative antibiotic regimen administered: once-daily ceftriaxone/metronidazole versus other regimens.
• To identify potential differences in abscess formation, wound infections, and readmissions.

Main Methods:

• Retrospective analysis of 123 pediatric patients undergoing appendectomy for perforated appendicitis between 2008 and 2013.
• Patients were categorized into two groups: those receiving daily ceftriaxone and metronidazole, and those receiving alternative antibiotic regimens.
• Primary outcome: hospital length of stay. Secondary outcomes: rates of abscess, wound infection, and 30-day readmissions.

Main Results:

• No statistically significant differences were observed in hospital length of stay (5.7 vs. 5.8 days, p=0.83) between the groups.
• Rates of postoperative abscess (8% vs. 4%, p=0.57), wound infection (5% vs. 2%, p=0.73), and 30-day readmissions (3% vs. 11%, p=0.19) were not significantly different.
• Despite no statistical significance, the group receiving ceftriaxone and metronidazole had a twofold higher rate of infectious complications.

Conclusions:

• Current postoperative antibiotic choices, including ceftriaxone/metronidazole, did not demonstrate statistically significant differences in key outcomes for perforated appendicitis in children.
• A trend towards higher infectious complications was noted with ceftriaxone and metronidazole, suggesting a potential risk.
• Further investigation through prospective randomized controlled trials is recommended to definitively assess the safety and efficacy of different antibiotic regimens.