Home intravenous versus oral antibiotics following appendectomy for perforated appendicitis in children: a randomized...

Area of Science:

• Pediatric Surgery
• Infectious Diseases
• Health Economics

Background:

• Appendectomy is a common surgical procedure for appendicitis.
• Perforated appendicitis, a severe form, often requires extensive antibiotic treatment.
• The route of antibiotic administration (intravenous vs. oral) can impact patient outcomes and healthcare costs.

Purpose of the Study:

• To compare the efficacy and resource utilization of home intravenous (IV) versus oral antibiotic therapy after appendectomy for perforated appendicitis.
• To evaluate complication rates and healthcare charges associated with different antibiotic administration routes.

Main Methods:

• A randomized controlled trial involving 82 patients (aged 4-17) with surgically treated perforated appendicitis.
• Patients received a 10-day course of either IV ertapenem or oral amoxicillin-clavulanate.
• Outcomes assessed included 30-day postoperative complication rates (abscess, readmission, wound infection) and total charges.

Main Results:

• No significant differences were observed in postoperative abscess rates (11.6% IV vs. 8.1% oral) or readmission rates (14.0% IV vs. 16.2% oral).
• Length of hospital stay was comparable between the IV and oral antibiotic groups (4.4 days for both).
• Total hospital and outpatient charges were significantly higher for patients receiving IV antibiotics compared to oral antibiotics (p < 0.0001).

Conclusions:

• Home-administered oral antibiotic therapy with amoxicillin-clavulanate provides equivalent clinical outcomes to IV ertapenem for perforated appendicitis.
• Oral antibiotic treatment significantly reduces healthcare costs compared to IV therapy in this patient population.
• Oral antibiotics represent a cost-effective and viable treatment option for selected patients following appendectomy for perforated appendicitis.