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Home Antibiotics at Discharge for Pediatric Complicated Appendicitis: Friend or Foe?

K Tinsley Anderson1, Marisa A Bartz-Kurycki1, Akemi L Kawaguchi2

  • 1Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Sciences Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, Houston, TX.

Journal of the American College of Surgeons
|April 23, 2018
PubMed

Insights

Home antibiotics at discharge for pediatric perforated appendicitis showed no significant benefit in a large study. Continued antibiotics may be needed for patients with more severe illness.

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Clinical Outcomes Research

Background:

  • The role of home antibiotics (HA) in pediatric perforated appendicitis is not well-defined.
  • This study investigates outcomes for children discharged with or without HA after initial treatment.

Purpose of the Study:

  • To evaluate the impact of home antibiotics on 30-day postdischarge morbidity in pediatric patients with complicated appendicitis.
  • To identify patient subgroups that may or may not benefit from home antibiotics.

Main Methods:

  • Utilized the 2015-2016 NSQIP-Pediatric database for patients under 18 with complicated appendicitis.
  • Stratified patients by HA use, presence of predischarge surgical site infection (SSI), and discharge timing (≤5 or >5 days postoperation).
  • Employed multivariable logistic regression to analyze 30-day composite morbidity, including ED visits, readmissions, reoperations, and SSIs.

Main Results:

  • The majority (56.4%) of 6,412 patients received HA, often indicating more severe illness (higher leukocytosis, sepsis, longer stay).
  • HA patients without predischarge SSI or discharged ≤5 days postoperation had higher postdischarge morbidity compared to NHA patients.
  • No significant difference in composite morbidity was observed between HA and NHA groups with predischarge SSIs or discharged >5 days postoperation.

Conclusions:

  • Despite common use, home antibiotics show no clear benefit for pediatric complicated appendicitis in this cohort.
  • A subset of patients with more severe disease may warrant continued antibiotic therapy post-discharge.
Abstract

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