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Antibiotic Treatment in Complicated Appendicitis: Can It Be Optimized?

Yael Dreznik1, Maya Paran1, Efraim Bilavsky2

  • 1Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

The Israel Medical Association Journal : IMAJ
|February 29, 2024
PubMed

Insights

For complicated appendicitis in children, generalized peritonitis and high C-reactive protein (CRP) levels indicate a need for broader antibiotic therapy, potentially tazobactam/piperacillin (TP), for better outcomes.

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Clinical Pharmacology

Background:

  • Management of complicated appendicitis lacks established guidelines for personalized antibiotic therapy.
  • Current approaches to pediatric complicated appendicitis require further refinement.

Purpose of the Study:

  • Identify specific risk factors for initial antibiotic selection in pediatric complicated appendicitis.
  • Optimize empirical antibiotic regimens based on patient-specific factors.

Main Methods:

  • Retrospective analysis of 300 pediatric patients (<18 years) undergoing laparoscopic appendectomy for complicated appendicitis (2012-2022).
  • Evaluation of initial antibiotic treatment with ceftriaxone + metronidazole (CM) and subsequent changes to tazobactam/piperacillin (TP).

Main Results:

  • 19% (57/300) of patients required a switch from CM to TP due to resistant bacteria or clinical deterioration.
  • Generalized peritonitis during surgery and C-reactive protein (CRP) > 20 mg/L at admission were significant risk factors for regimen change.

Conclusions:

  • Generalized peritonitis and elevated CRP levels (>20 mg/L) are strong predictors for switching to tazobactam/piperacillin (TP).
  • Initial empirical treatment with TP for high-risk pediatric patients may improve clinical outcomes and reduce hospitalization duration.
Abstract

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