Extended Antibiotic Course Prior to Interval Appendectomy in Children with Complicated Appendicitis Offers No
Faidah Badru1,2, Nicholas Piening2, Jose Greenspon1,2
11 Cardinal Glennon Children's Medical Center , St. Louis, Missouri.
Insights
For complicated appendicitis treated with interval appendectomy, antibiotic therapy longer than two weeks does not reduce complication rates. Prolonged antibiotic use offers no clinical benefit before surgery.
Area of Science:
- Surgery
- Infectious Diseases
- Clinical Medicine
Background:
- Consensus is lacking on optimal antibiotic duration for complicated appendicitis managed with interval appendectomy.
- This study investigates if extended antibiotic therapy beyond two weeks impacts complication rates.
Purpose of the Study:
- To determine if antibiotic therapy exceeding two weeks reduces complications in patients with complicated appendicitis undergoing interval appendectomy.
- To evaluate the clinical benefit of prolonged antibiotic treatment before interval appendectomy.
Main Methods:
- Retrospective review of 158 patients with complicated appendicitis treated with interval appendectomy (2010-2015).
- Patients were divided into two groups: ≤2 weeks of antibiotics (Group 1) and >2 weeks (Group 2).
- Complication rates were compared between groups using Pearson chi-square and Student t-tests (p<0.05 significance).
Main Results:
- No significant difference in overall complication rates between the two antibiotic duration groups (p=1.0).
- Specific complications like abscess, re-admissions, and fistula were analyzed, with no statistically significant reduction observed with longer antibiotic courses.
- All recorded fistula cases and conversions to open surgery occurred in the group receiving less than two weeks of antibiotics.
Conclusions:
- Antibiotic therapy exceeding two weeks provides no discernible clinical benefit for complicated appendicitis prior to interval appendectomy.
- Prolonged antibiotic treatment does not lead to a reduction in post-operative complications.
Background:
No consensus exists regarding duration of antibiotic therapy for complicated appendicitis treated with interval appendectomy. We hypothesized that more than two weeks of antibiotic therapy does not decrease complication rates in asymptomatic patients.
Patients And Methods:
A retrospective review of all patients with complicated appendicitis treated with interval appendectomy from 2010-2015 was performed. We divided the patients in two groups (group 1, ≤2 weeks of antibiotics; group 2: >2 weeks of antibiotics). Demographics, antibiotic agents, and complications were collected. Pearson χ analysis and Student t-test analysis was performed with significance of p < 0.05.
Results:
Total of 158 patients met inclusion criteria (group 1 [47.4%] vs. group 2 [52.5%]). Mean length of stay was 7.5 days. Abscess on admission was 26% (n = 41). The groups were demographically similar. Total complication rate was 39.2% (abscess development, n = 19; re-admissions, n = 16; interval appendectomy <28 days, n = 13; unplanned emergency department visits, n = 7; fistula, n = 4, wound infection/dehiscence, n = 3; and conversion to open surgery, n = 4). All fistulas and conversions occurred in the less than two-week group. Mean course of antibiotics was 4.1 weeks. There was no significant difference in the complication rates based on duration or type of antibiotics (p = 1.0).
Conclusion:
Treatment with more than two weeks of antibiotic therapy for complicated appendicitis does not confer any clinical benefit prior to interval appendectomy. Complications were not reduced by a prolonged course of antibiotic therapy.
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