Eur J Pediatr Surg
DOI: 10.1055/s-0037-1606847
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Dual versus Triple Antibiotics Regimen in Children with Perforated Acute Appendicitis

Yael Dreznik
1  Department of General Surgery, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
,
Elad Feigin
2  Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
,
Inbal Samuk
2  Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
,
Dragan Kravarusic
2  Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
,
Artur Baazov
2  Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
,
Itzhak Levy
3  Department of Infectious Diseases, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
,
Gilat Livni
3  Department of Infectious Diseases, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
,
Enrique Freud
2  Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
› Author Affiliations
Further Information

Publication History

21 September 2016

14 August 2017

Publication Date:
25 September 2017 (eFirst)

Abstract

Introduction Acute appendicitis is the most common emergency condition in pediatric surgery. Historically, a triple-antibiotic therapy consisted of ampicillin, gentamicin, and clindamycin has been used postoperatively for perforated appendicitis. According to recently published trials, dual therapy consists of ceftriaxone and metronidazole only, offers a more efficient and cost-effective antibiotic management compared with triple therapy. Based on these results, our department applied dual antibiotic therapy for children with perforated appendicitis that underwent appendectomy from 2009 and forth.

Aim The aim of our study was to compare postoperative outcomes between patients treated with triple therapy (ampicillin, gentamicin, and metronidazole) (group A) versus dual therapy (ceftriaxone and metronidazole) (group B).

Methods Clinical and laboratory data were retrospectively collected by review of the medical records for all children who underwent appendectomy for the perforated appendix at the Schneider Children's Medical Center of Israel, a tertiary pediatric care center between 2007 and 2011. Children with perforated appendicitis received antibiotic therapy in accordance with the hospital's guidelines that were valid at the time the surgery took place. In the first period (years 2007–2009) (group A) a triad of ampicillin, gentamicin, and metronidazole and the second period (2009–2011) (group B) dual therapy consists of ceftriaxone and metronidazole. The two groups were compared for outcome and complications, such as wound infections, changing of antibiotic therapy, and length of stay.

Results During the study period 1,203 patients underwent an appendectomy. Of these, 175 patients were diagnosed with perforated appendix and were treated with postoperative antibiotic's regimen. Group A and group B consisted of 89 and 86 patients, respectively. The two groups were not different significantly in terms of demographic data, length of stay, or readmission rates. However, more rates of wound infection and changing of antibiotic therapy were seen in group B, although not statistically significant (p = 0.064).

Conclusion Dual antibiotic therapy for perforated appendicitis is a cost-effective and efficient mode of therapy compared with triple-antibiotic's regimen. However, prospective studies are required to determine whether this policy is associated with higher rates of wound infections and change in antibiotic therapy.

This article is dedicated to the memory of the beloved Dr. Elad Feigin who passed away during its preparation.