Antibiotic Treatment in Complicated Appendicitis: Can It Be Optimized?

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.