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Antibiotic monotherapy vs dual-drug therapy in perforated appendicitis: single-center retrospective review

Shai Stewart1, Cory Nonnemacher2, Seth Saylors1

  • 1Department of Pediatric Surgery, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA.

Pediatric Surgery International
|July 22, 2025
PubMed
Abstract

Insights

Piperacillin-Tazobactam (PT) monotherapy and Ceftriaxone and Metronidazole (CM) dual-drug therapy are equally effective in preventing intra-abdominal abscesses in children with perforated appendicitis. This study found no significant difference in outcomes between the two antibiotic regimens.

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Pharmacology

Background:

  • Optimal antibiotic regimens for perforated appendicitis lack consensus.
  • This study compares Piperacillin-Tazobactam (PT) monotherapy with Ceftriaxone and Metronidazole (CM) dual-drug therapy.
  • The hypothesis is that monotherapy is equivalent to dual-drug therapy in preventing intra-abdominal abscess (IAA).

Purpose of the Study:

  • To evaluate and compare the outcomes of perforated appendicitis treatment using PT monotherapy versus CM dual-drug therapy.
  • To determine if antibiotic choice impacts the rate of postoperative intra-abdominal abscess (IAA) formation.
  • To assess other clinical outcomes such as length of stay and emergency room visits.

Main Methods:

  • Retrospective review of pediatric patients (<18 years) with perforated appendicitis.
  • Data collected from October 2019 to March 2020 and October 2021 to May 2022.
  • Primary outcome: 30-day postoperative IAA formation.

Main Results:

  • 117 patients analyzed; 77 in CM group, 40 in PT group.
  • No significant differences in symptom duration, length of stay, or antibiotic treatment duration.
  • CM group showed a trend towards fewer IAA (13% vs 20%) and ER visits (14.3% vs 27.5%), but not statistically significant. Antibiotic choice was not a significant predictor for IAA.

Conclusions:

  • Piperacillin-Tazobactam monotherapy and Ceftriaxone/Metronidazole dual-drug therapy are equivalent for treating perforated appendicitis in children.
  • Both regimens result in similar rates of intra-abdominal abscess formation.
  • Antibiotic choice did not significantly predict IAA development in this cohort.
Keywords:
AbscessAppendicitisCeftriaxoneMetronidazoleRocephin flagylZosyn

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