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Published on: December 31, 2017
Efficacy of oral antibiotics in children with post-operative abscess from perforated appendicitis
Joseph A Sujka1, Katrina L Weaver1, Justin A Sobrino1
1Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, 64108, Kansas City, MO, USA.
Insights
Oral antibiotics are effective for treating post-operative intra-abdominal abscess (PIAA) after perforated appendicitis (PA). This approach leads to shorter hospital stays and fewer medical visits compared to intravenous antibiotics.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
Background:
- Post-operative intra-abdominal abscess (PIAA) is a common complication following appendectomy for perforated appendicitis (PA).
- Current treatment typically involves intravenous (IV) antibiotics administered via peripherally inserted venous catheters.
- The study evaluates the efficacy of oral antibiotic therapy as an alternative treatment modality.
Purpose of the Study:
- To assess the role and outcomes of oral antibiotic treatment for PIAA in children.
- To compare the effectiveness of oral versus IV antibiotic regimens for PIAA management.
Main Methods:
- Retrospective review of pediatric patients diagnosed with PIAA between January 2005 and September 2015.
- Analysis of demographics, clinical course, complications, and follow-up data.
- Comparative statistical analysis between patients treated with oral and IV antibiotics.
Main Results:
- 103 children were included in the study.
- Patients treated with IV antibiotics had a significantly longer hospital stay (10.7 days vs. 9.1 days, p=0.02) and required more medical encounters (4.4 vs. 3.4, p≤0.01) compared to those on oral antibiotics.
- No significant difference in overall treatment outcomes was observed between the two groups.
Conclusions:
- Oral antibiotic therapy is a viable and effective treatment option for PIAA following appendectomy for PA.
- Switching to oral antibiotics can lead to reduced hospitalizations and fewer required medical visits.
- This approach offers comparable outcomes to IV antibiotic treatment with improved resource utilization.
Background:
Post-operative intra-abdominal abscess (PIAA) is the most common complication after appendectomy for perforated appendicitis (PA). Typically, intravenous antibiotics by a peripherally inserted venous catheter are utilized to treat the abscess. We sought to evaluate the role of oral antibiotics in this population.
Methods:
This is a retrospective review conducted of children between January 2005 and September 2015 with a PIAA. Demographics, clinical course, complications, and follow-up were analyzed using descriptive statistics. Comparative analysis was performed on those who were treated with oral vs IV antibiotics after diagnosis of PIAA.
Results:
103 children were included. Days of symptoms prior to admission were 3.2 ± 2.3 days with a WBC of 17.9 ± 6.4. Median time to diagnosis of PIAA from appendectomy was 7 days (7, 10). Mean total length of stay was 10 ± 3.4 days. 42% were treated with oral antibiotics (n = 43) versus 58% IV antibiotics (n = 60) at the time of discharge. We found a significant increase in total length of hospital stay (9.1 vs 10.7, p = 0.02) and number of medical encounters required for treatment (3.4 vs 4.4, p ≤ 0.01) in the IV group.
Conclusions:
PIAA treatment after appendectomy for PA can be treated with oral antibiotics with equivalent outcomes as IV antibiotic treatment, but with shorter length of hospitalizations and less medical encounters required.
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