Antibiotic monotherapy vs dual-drug therapy in perforated appendicitis: single-center retrospective review.

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.