Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA.
J Pediatr Surg. 2010 Jun;45(6):1198-202. doi: 10.1016/j.jpedsurg.2010.02.090.
In a previous prospective randomized trial, we found a once-a-day regimen of ceftriaxone and metronidazole to be an efficient, cost-effective treatment for children with perforated appendicitis. In this study, we evaluated the safety of discharging patients to complete an oral course of antibiotics.
Children found to have perforated appendicitis at the time of laparoscopic appendectomy were enrolled in the study. Perforation was defined as a hole in the appendix or fecalith in the abdomen. Patients were randomized to antibiotic treatment with either once daily dosing of ceftriaxone and metronidazole for a minimum of 5 days (intravenous [IV] arm) or discharge to home on oral amoxicillin/clavulanate when tolerating a regular diet (IV/PO arm) to complete 7 days.
One hundred two patients underwent laparoscopic appendectomy for perforated appendicitis. On presentation, there were no differences in age, weight, sex distribution, days of symptoms, maximum temperature, or leukocyte count between the 2 groups. There was no difference in the postoperative abscess rate between the two treatment groups. Discharge was possible before day 5 in 42% of the patients in the IV/PO arm.
When patients are able to tolerate a regular diet, completing the course of antibiotics orally decreases hospitalization with no effect on the risk of postoperative abscess formation.
在之前的一项前瞻性随机试验中，我们发现头孢曲松和甲硝唑每日一次的方案治疗穿孔性阑尾炎是一种有效且具有成本效益的治疗方法。在这项研究中，我们评估了让患者出院完成口服抗生素疗程的安全性。
在腹腔镜阑尾切除术中发现穿孔性阑尾炎的患儿被纳入研究。穿孔定义为阑尾有孔或腹部有粪石。患者被随机分配接受抗生素治疗，一组接受头孢曲松和甲硝唑每日一次的方案治疗，至少 5 天（静脉[IV]组），另一组在能够耐受常规饮食时出院，口服阿莫西林/克拉维酸钾完成 7 天（IV/PO 组）。
102 例患儿因穿孔性阑尾炎接受腹腔镜阑尾切除术。在就诊时，两组间在年龄、体重、性别分布、症状持续天数、最高体温或白细胞计数方面无差异。两组术后脓肿发生率无差异。在 IV/PO 组，42%的患者可在第 5 天前出院。
当患者能够耐受常规饮食时，口服完成抗生素疗程可减少住院时间，而不会影响术后脓肿形成的风险。
