Nadler Evan P, Gaines Barbara A
Division of Pediatric Surgery, Department of Surgery, New York University School of Medicine, New York, New York 10016, USA.
Surg Infect (Larchmt). 2008 Feb;9(1):75-83. doi: 10.1089/sur.2007.072.
The Surgical Infection Society published their most recent recommendations for antimicrobial therapy in patients with intra-abdominal infections in 2002. These guidelines outlined several important considerations for the treatment of such infections, including which patients require antimicrobial agents, the appropriate duration of treatment, which antimicrobial regimens are appropriate, and the risk factors and indications for intensified regimens. However, the applicability of these recommendations to the pediatric population is not entirely clear.
Systematic review of all literature regarding antimicrobial therapy in the most common intra-abdominal infection in children, appendicitis, with the goal of establishing guidelines for use.
Children with uncomplicated (acute or gangrenous), but not perforated, appendicitis can be treated with prophylactic antimicrobial agents for 24 h or less. Children with perforated appendicitis can be treated after appendectomy in the same manner as adults with established intra-abdominal infections; i.e., with therapeutic antibiotics until no clinical evidence of infection exists. This is true after both laparoscopic and open operations. Whereas "triple" antibiotic therapy has been the gold standard in pediatric patients, monotherapy with broad-spectrum agents is equally effective and possibly more cost-effective. The nonoperative management of perforated appendicitis with interval appendectomy represents a unique problem, and guidelines for therapy are less well established.
The evidence supports using guidelines in the pediatric population similar to those suggested for the adult population for the management of acute appendicitis.
外科感染协会于2002年发布了关于腹腔内感染患者抗菌治疗的最新建议。这些指南概述了治疗此类感染的几个重要考虑因素，包括哪些患者需要使用抗菌药物、适当的治疗持续时间、哪些抗菌方案合适，以及强化方案的风险因素和适应症。然而，这些建议对儿科人群的适用性尚不完全明确。
系统回顾所有关于儿童最常见腹腔内感染（阑尾炎）抗菌治疗的文献，目的是制定使用指南。
患有非复杂性（急性或坏疽性）但未穿孔阑尾炎的儿童可用预防性抗菌药物治疗24小时或更短时间。穿孔性阑尾炎患儿在阑尾切除术后的治疗方式与患有确诊腹腔内感染的成人相同；即使用治疗性抗生素，直至没有感染的临床证据。腹腔镜手术和开放手术后均如此。虽然“三联”抗生素疗法一直是儿科患者的金标准，但使用广谱药物进行单一疗法同样有效，而且可能更具成本效益。采用间隔期阑尾切除术对穿孔性阑尾炎进行非手术治疗是一个独特的问题，治疗指南尚不完善。
有证据支持在儿科人群中使用与成人急性阑尾炎管理建议类似的指南。
