Postoperative antibiotic therapy for children with perforated appendicitis: long course of intravenous antibiotics versus early conversion to an oral regimen

Abstract 

Background

Although treatment for nonperforated acute appendicitis is usually straightforward, the optimal treatment of patients with perforated appendicitis remains controversial.

Methods

Our institution performed a 2.5-year retrospective review of outcomes for postoperative treatment of perforated appendicitis. Patients were treated with either short-term intravenous (IV) antibiotic therapy and conversion to PO antibiotics (PO group) or long-term antibiotic therapy by way of a peripherally inserted central venous catheter (IV group).

Results

One-hundred forty-nine patients with a diagnosis of perforated appendicitis were reviewed. There were 47 patients in the PO group and 102 patients in the IV group. In the IV group, there were 2 intra-abdominal abscesses (2%) requiring readmission; there were also 2 intra-abdominal abscesses in the PO group (4.2%). Outpatient conversion to PO antibiotics resulted in an average savings of approximately $4,000/patient.

Conclusions

Inpatient IV antibiotic therapy followed by outpatient conversion to PO antibiotics is a safe and cost-effective treatment of perforated appendicitis.

Keywords: Intravenous antibiotics, Oral antibiotics, Perforated appendicitis, Postoperative antibiotic therapy