Related Experiment Video
Updated: Jan 7, 2026
Murine Appendectomy Model of Chronic Colitis Associated Colorectal Cancer by Precise Localization of Caecal Patch
Published on: August 24, 2019
Effectiveness and Safety of Shortened Postoperative Antibiotic Regimens in Children with Perforated Appendicitis: A
Pia Löfgren1, Elias Berge1, Elisabeth M L de Wijkerslooth2
1Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
Insights
Shortened antibiotic regimens for pediatric perforated appendicitis did not prove non-inferior for preventing intra-abdominal abscesses but may reduce hospital stays. Further research is needed to determine optimal antibiotic duration.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Clinical Pharmacy
Background:
- Postoperative antibiotic therapy is standard for perforated appendicitis to prevent complications.
- Optimal antibiotic duration in pediatric patients with perforated appendicitis remains unclear.
Purpose of the Study:
- To systematically review the evidence on shortened postoperative antibiotic regimens in children with perforated appendicitis.
- To assess patient risks and benefits, focusing on intra-abdominal abscess development.
Main Methods:
- Systematic review of Medline, Embase, Cochrane Library, and CINAHL databases (October 2023).
- Included studies meeting PICO criteria: pediatric perforated appendicitis patients, comparing shorter vs. longer antibiotic durations.
- Assessed intra-abdominal abscess as the primary outcome for non-inferiority.
Main Results:
- Pooled data from two randomized controlled trials (RCTs) showed a wide confidence interval for intra-abdominal abscesses, failing to meet non-inferiority criteria (<5 vs. 5 days IV antibiotics).
- One RCT indicated no significant difference in readmissions or complications between 2 vs. 5 days of IV antibiotics.
- Two RCTs reported a significantly shorter hospital stay for patients receiving shorter antibiotic courses.
Conclusions:
- Shortened postoperative antibiotic regimens in pediatric perforated appendicitis do not demonstrate non-inferiority for preventing intra-abdominal abscesses.
- Evidence suggests no significant difference in readmission or treatment-related complications.
- Shorter regimens may offer benefits like reduced hospital stay, but further RCTs are required to establish optimal duration.
Background:
Postoperative antibiotic treatment of varying length is routinely used in perforated appendicitis to reduce the risk of complications. In the pediatric population, outcomes of shortened antibiotic regimens have not been specifically reviewed.
Methods:
Medline, Embase, the Cochrane Library, and CINAHL were searched (October 2023): P, patients: Children with perforated appendicitis; I, intervention and C, comparison: Antibiotic regimen below (I) and above (C) a defined number of days; O, outcomes, focus: Patient risks and benefits. For the main outcome (intra-abdominal abscess), non-inferiority was assessed.
Results:
Three randomized controlled trials (RCTs; 215 children) and one non-randomized study (288 children) fulfilled the PICO criteria. Regarding intra-abdominal abscess, pooling data from two RCTs (<5 vs. 5 days of intravenous antibiotics; 16 (17%) vs. 15 [15%] events) resulted in a wide 95% confidence interval (risk difference: -8 to 12 percentage points) not meeting the predefined non-inferiority margin of 7.5. One RCT (2 vs. 5 days of intravenous antibiotics) provided data regarding readmissions (9 vs. 7 events) and complications to antibiotic treatment (8 vs. 9 events). Two RCTs (<5 vs. 5 days of intravenous antibiotics) reported significantly shorter length of stay in the intervention group.
Conclusion:
This systematic review shows neither non-inferiority nor an increased risk of intra-abdominal abscess with a shortened postoperative antibiotic regimen. There may be no difference regarding readmission rates and treatment-related complications. Shorter regimens probably offer the advantage of reduced hospital stay. Due to substantial uncertainties, further RCTs are needed to define the optimal duration of antibiotics in children.
More Related Videos
Related Concept Videos
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:22Appendicitis-I: Introduction
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:22Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption