Highlights
- •Management of antibiotics after pediatric perforated appendicitis is variable.
- •No antibiotics at discharge did not increase abscess rates or readmissions.
- •Multi-institutional studies are needed for optimal management of antibiotics.
Abstract
Background
Postoperative oral antibiotic management at discharge for perforated appendicitis
varies by institution. A prior study at our institution led to a decrease in antibiotic
therapy in patients without leukocytosis. A subsequent protocol change eliminated
the white blood cell count check and oral antibiotics if discharge criteria were met
by postoperative day seven. We hypothesized this change could be made without an increase
in abscess or readmission rates.
Methods
We conducted a retrospective review of patients with perforated appendicitis over
two 1-year periods after institutional review board approval (262061). In the pre-protocol
group, a white blood cell count was checked at discharge and patients with leukocytosis
were prescribed oral antibiotics to complete a total of 7 d. In the post-protocol
group, no white blood cell count was checked and patients were discharged home without
antibiotics.
Results
There were a total of 174 patients with complicated appendicitis in the two 1-year
periods with 129 (74%) patients with perforated appendicitis discharged before postoperative
day seven. The pre-protocol group included 71 children, and post-protocol included
58 children. There were no differences between mean postoperative days to discharge
(2.57 versus 3, P = 0.0896), postoperative abscess rate (12.7% versus 12.1%, P = 1.0000), or readmission rate (12.7% versus 17.2%, P = 0.6184). None of the patients in the post-protocol group were discharged home with
oral antibiotics compared with 22.5% in the pre-protocol group (P < 0.001).
Conclusions
For pediatric patients with perforated appendicitis discharged before postoperative
day seven, stopping antibiotics at the time of discharge significantly decreased our
home antibiotic use without an increase in postoperative morbidity.
Keywords
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Article info
Publication history
Published online: February 27, 2021
Accepted:
December 26,
2020
Received in revised form:
December 15,
2020
Received:
June 13,
2020
Identification
Copyright
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