Antibiotic Monotherapy vs Dual-drug Therapy in Perforated Appendicitis: Single-center Retrospective Review

Document Type

Article

Publication Title

Pediatric Surgery International

Abstract

Background: There is no consensus on the optimal antibiotic regimen in perforated appendicitis. We aimed to evaluate the outcomes of patients with perforated appendicitis when treated with Piperacillin-Tazobactam (PT) monotherapy versus Ceftriaxone and Metronidazole (CM) dual-drug therapy. We hypothesized that there is no difference in the rate of intraabdominal abscess (IAA) formation with antibiotic monotherapy, as opposed to our institutional standard dual-drug therapy.

Methods: Single institution retrospective review of children < 18 years old with perforated appendicitis from October 2019 to March 2020 and October 2021 to May 2022 at a free-standing pediatric hospital. The primary outcome was 30-day postoperative IAA formation.

Results: One hundred and seventeen patients were identified during the study periods; N = 77 in the CM group and N = 40 in the PT group. No differences in symptom duration, postoperative length of stay (LOS), duration of intravenous antibiotic treatment, or discharge oral antibiotic treatment were identified. Compared to the PT group, those treated with CM had fewer IAA (13% vs 20%, P = 0.32) and fewer emergency room visits (14.3% vs 27.5%, P = 0.08) but did not have statistically significant differences. Multivariate logistic regression analysis did not find antibiotic choice to be a significant predictor for developing IAA [OR 1.78, P = 0.21].

Conclusions: In children with perforated appendicitis, postoperative monotherapy with PT and standard dual-drug therapy with CM are equivalent with respect to IAA formation at our institution.

DOI

10.1007/s00383-025-06129-0

Publication Date

7-22-2025

Keywords

Abscess, Appendicitis, Ceftriaxone, Metronidazole, Rocephin flagyl, Zosyn

ISSN

1437-9813

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