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Postoperative Antibiotics for Complicated Appendicitis in Children: Piperacillin/Tazobactam Versus Ceftriaxone with

Suhail Zeineddin1, J Benjamin Pitt1, Samuel Linton1

  • 1Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.

Journal of Pediatric Surgery
|March 17, 2023
PubMed
Abstract

Insights

Piperacillin/tazobactam (PT) use in pediatric appendicitis was linked to more abscesses and readmissions than ceftriaxone/metronidazole (CM). However, this difference disappeared when accounting for hospital practices, suggesting antibiotic choice may be less critical than adherence to guidelines.

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Pharmacology

Background:

  • Conflicting evidence exists on postoperative antibiotic choice for pediatric complicated appendicitis.
  • Piperacillin/tazobactam (PT) may reduce abscesses, while ceftriaxone/metronidazole (CM) offers stewardship and dosing benefits.

Purpose of the Study:

  • To compare postoperative outcomes associated with PT versus CM in pediatric complicated appendicitis.
  • To analyze trends in antibiotic utilization using a large administrative database.

Main Methods:

  • Retrospective comparative study of 29,015 pediatric patients (2-18 years) undergoing laparoscopic appendectomy for complicated appendicitis (2016-2021).
  • Patients were categorized based on first postoperative day antibiotics: PT, CM, or other.
  • Evaluation of adverse events, including intraabdominal abscess and readmission rates.

Main Results:

  • CM was used in 51.9% and PT in 31.3% of patients.
  • The overall abscess rate was 9.2%.
  • Multivariable analysis initially showed PT associated with higher abscess risk (RR 1.35) and readmission (RR 1.38) compared to CM, but these associations became non-significant after adjusting for hospital-level CM prevalence.

Conclusions:

  • Postoperative PT use for complicated appendicitis showed higher initial associations with intraabdominal abscess and readmission compared to CM.
  • The observed effect of PT was mitigated when adjusted for common practice patterns, indicating the importance of considering institutional antibiotic prescribing habits.
Keywords:
Antibiotic stewardshipAppendectomyAppendicitisPostoperative abscess

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