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Piperacillin/tazobactam versus ceftriaxone/metronidazole for children with perforated appendicitis: a systematic
Jennifer Armstrong1,2, Jhanahan Sriranjan3, Daniel Briatico2,4
1Meharry Medical College, Nashville, TN, USA.
Insights
For children with perforated appendicitis, this review found no significant difference in outcomes between piperacillin/tazobactam and ceftriaxone/metronidazole post-operative antibiotics. Further research is needed to determine the optimal antibiotic regimen for pediatric perforated appendicitis.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Clinical Pharmacology
Background:
- Acute appendicitis is common in children, often treated with surgery and antibiotics.
- Perforated appendicitis requires careful post-operative antibiotic selection.
- Current antibiotic choices for pediatric perforated appendicitis vary.
Purpose of the Study:
- To compare the efficacy and safety of piperacillin/tazobactam versus ceftriaxone and metronidazole as post-operative antibiotics in children with perforated appendicitis.
Main Methods:
- Systematic literature search of Medline, Embase, and Cochrane databases.
- Included comparative studies of pediatric perforated appendicitis patients receiving piperacillin/tazobactam or ceftriaxone/metronidazole post-operatively.
- Meta-analysis of outcomes including surgical site infections, imaging, and hospital readmissions.
Main Results:
- Four studies (25,730 children) were included: one RCT and three observational studies.
- No significant differences were found between antibiotic groups for deep surgical site infections, post-operative imaging, emergency department returns, or readmissions.
- Substantial heterogeneity was noted across studies, with potential biases in the included RCT and observational studies.
Conclusions:
- Current evidence suggests no clear advantage of piperacillin/tazobactam over ceftriaxone/metronidazole for post-operative treatment of perforated appendicitis in children.
- Uncertainty remains regarding the optimal antibiotic strategy.
- Further high-quality research is warranted to guide clinical practice.
Purpose:
Most children with acute appendicitis are treated with laparoscopic appendectomy followed by antibiotics if the appendix is found to be perforated. There is variation in the type of post-operative antibiotics used for these patients.
Methods:
We conducted systematic searches of Medline, Embase, and Cochrane for comparative studies of children with perforated appendicitis treated with post-operative piperacillin/tazobactam versus ceftriaxone and metronidazole.
Results:
We identified four studies consisting of 25,730 children with perforated appendicitis treated with laparoscopic appendectomy followed by post-operative piperacillin/tazobactam (n = 9,950) or ceftriaxone and metronidazole (n = 15,780). One study was a randomized controlled trial (RCT) and three were multicenter observational studies. Meta-analysis suggested no differences between piperacillin/tazobactam and ceftriaxone and metronidazole in terms of deep/organ-space surgical site infection (risk ratio [RR] = 0.97, 95% confidence interval [CI] 0.57-1.65), post-operative imaging (RR = 0.99, 95% CI 0.71-1.37), return to the emergency department (RR = 0.82, 95% CI 0.50-1.37), and readmission to hospital (RR = 0.85, 95% CI 0.45-1.62). Heterogeneity between studies was substantial (I2 73-83%). The RCT was limited by possible ascertainment bias, while the three observational studies may have been affected by baseline differences between treatment groups.
Conclusion:
This systematic review suggests that there is ongoing uncertainty regarding the optimal post-operative antibiotics for children with perforated appendicitis.
Clinical Trial Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD42023421492 .
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