Ertapenem Monotherapy versus Gentamicin Plus Metronidazole for Perforated Appendicitis in Pediatric Patients

This study evaluated the efficacy and safety of ertapenem versus a combination of gentamicin plus metronidazole in pediatric patients with diffuse peritonitis attributable to perforated appendicitis. From January 2017 to January 2019, 80 pediatric patients with a median age of 13 years who underwent laparoscopic appendectomy because of perforated appendicitis with diffuse peritonitis were enrolled. The patients were randomly assigned to two groups of 40 patients each to receive ertapenem or combination therapy. The groups were compared regarding demographic/clinical data and outcomes of treatment. The main outcome measures were duration of hospitalization, time to achieving an afebrile state, post-operative complications, antibiotic treatment failure, and time to the start of enteral feeding. The median length of the hospital stay was 5 and 8 days in the ertapenem and combination therapy groups, respectively (p < 0.0001). Patients in the ertapenem group took two days less to become afebrile (p < 0.0001). No post-operative complications were recorded in the ertapenem group, whereas in the combination therapy group, three complications were noted, but this difference was not significant (p = 0.2392). Furthermore, all patients in the ertapenem group responded to therapy, whereas in the combination therapy group, two antibiotic treatment failures were recorded, a diffrence that again was not significant (p = 0.4739). There was no difference in the time to the start of enteral feeding in the two groups. Both ertapenem and gentamicin plus metronidazole are safe and effective therapeutic options for the treatment of diffuse peritonitis in pediatric patients. Treatment with ertapenem results in lower complication rates, a shorter time to an afebrile state, and a shorter hospital stay.