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.
Keywords
perforated appendicitis - dual therapy - triple therapy
