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Extended Versus Narrow-spectrum Antibiotics in the Management of Uncomplicated Appendicitis in Children: A

Danielle B Cameron1, Patrice Melvin2, Dionne A Graham2

  • 1Department of Surgery, Boston Children's Hospital - Harvard Medical School, Boston, MA.

Annals of Surgery
|June 28, 2017
PubMed

Insights

Extended-spectrum antibiotics did not reduce surgical site infections or hospital revisits in children with appendicitis compared to narrow-spectrum options. This finding questions the routine use of broader-spectrum antibiotics in such cases.

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Pharmacology

Background:

  • Surgical site infections (SSIs) and hospital revisits are potential complications following appendectomy in children.
  • Evidence comparing extended-spectrum versus narrow-spectrum antibiotics for preventing SSIs in pediatric uncomplicated appendicitis is limited.

Purpose of the Study:

  • To compare the effectiveness of extended-spectrum antibiotics versus narrow-spectrum antibiotics in preventing SSIs and hospital revisits in children with uncomplicated appendicitis.

Main Methods:

  • A retrospective study using data from the ACS NSQIP-Pediatric Appendectomy Pilot Project and the Pediatric Health Information System database.
  • Patients undergoing appendectomy for uncomplicated appendicitis were propensity matched.
  • Comparison between piperacillin/tazobactam (extended spectrum) and cefoxitin or ceftriaxone with metronidazole (narrow spectrum).

Main Results:

  • No significant difference in 30-day SSI rates between extended-spectrum (2.4%) and narrow-spectrum (1.8%) antibiotic groups.
  • No significant difference in hospital revisit rates between the groups (7.9% vs 5.1%).

Conclusions:

  • Extended-spectrum antibiotics are not associated with lower rates of SSI or hospital revisits compared to narrow-spectrum antibiotics in pediatric uncomplicated appendicitis.
  • Findings challenge the routine use of extended-spectrum antibiotics, considering the rise of antibiotic-resistant organisms.
Abstract

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