Roque Fátima Maria Castelo Branco, Melo Filho Antônio Aldo, Roque Alberto Jorge Castelo Branco, Roque Hanne Castelo Branco, Moreira Thereza Maria Magalhães, Chaves Edna Maria Camelo
Universidade Estadual do Ceará, Fortaleza, CE, Brazil.
Universidade Federal do Ceará, Fortaleza, CE, Brazil.
Rev Paul Pediatr. 2019 Jul 4;37(4):494-502. doi: 10.1590/1984-0462/;2019;37;4;00013. eCollection 2019.
To analyze the preoperative use of antibiotics in children and adolescents requiring appendectomy.
Integrative review was performed in the MEDLINE, Latin American and Caribbean Health Sciences (LILACS) and Cochrane databases and the PubMed portal, with no time limit. The keywords used were: appendicitis, child, adolescent and antibacterial with Boolean AND. The articles included were published in Portuguese, English or Spanish and whose participants were under 18 years of age. Review articles and guidelines were excluded. The studies were classified according to their level of evidence and 24 papers were selected.
Seven randomized clinical trial studies (level of evidence II), eight cohorts (level III), seven retrospective observational studies (level V) and two historical documentary analysis (level IV) were selected. The studies addressed antibiotics used in acute appendicitis in both uncomplicated and complicated cases. Antibiotics initiated in the preoperative period showed a decrease in the rates of surgical wound infections. First-line (empiric) regimens were tested for sensitivity to microorganisms in peritoneal material cultures, however the results were controversial. Broad-spectrum antibiotics have been suggested in some studies because they have good coverage, but in others they have not been recommended because of the risk of developing bacterial resistance. Shorter administration time and earlier change to the oral route reduced hospitalization time.
There are several clinical protocols with different antibiotics. However, there is no standardization concerning the type of antibiotic drug, time of use, or route.
分析需要进行阑尾切除术的儿童和青少年术前抗生素的使用情况。
在MEDLINE、拉丁美洲和加勒比健康科学（LILACS）以及Cochrane数据库和PubMed门户中进行了综合综述，无时间限制。使用的关键词为：阑尾炎、儿童、青少年和抗菌药物，采用布尔逻辑与运算。纳入的文章以葡萄牙语、英语或西班牙语发表，参与者年龄在18岁以下。排除综述文章和指南。根据证据水平对研究进行分类，共选择了24篇论文。
选择了七项随机临床试验研究（证据水平II）、八项队列研究（证据水平III）、七项回顾性观察研究（证据水平V）和两项历史文献分析（证据水平IV）。这些研究涉及单纯性和复杂性急性阑尾炎中使用的抗生素。术前使用抗生素可降低手术伤口感染率。对一线（经验性）治疗方案进行了腹膜材料培养中微生物敏感性测试，然而结果存在争议。一些研究建议使用广谱抗生素，因为它们具有良好的覆盖范围，但另一些研究则因存在产生细菌耐药性的风险而不推荐使用。缩短给药时间并尽早改为口服途径可减少住院时间。
有几种使用不同抗生素的临床方案。然而，在抗生素药物类型、使用时间或途径方面没有标准化。
