Antibiotic choice has minimal impact on appendicitis complications

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Pip/tazo or narrower antibiotics for appendicitis?
In both complicated and uncomplicated appendicitis, it probably doesn't matter whether you give a broader spectrum drug or narrower spectrum drug.  And the extended spectrum cohort may actually do worse.  Of course, this could be confounding, because sicker patients may have been preferentially given broader antibiotic coverage.  But they did meticulous statistical analysis to control for this, and the extended spectrum antibiotic patients still appeared to have more delayed complications, namely 30-day readmission for wound infection or repeat abdominal surgery.

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It probably doesn't matter what antibiotic you choose to treat patients with appendicitis, whether complicated or uncomplicated.


Abstract

Pediatrics. 2016 Jul;138(1). pii: e20154547. doi: 10.1542/peds.2015-4547.

Extended- Versus Narrower-Spectrum Antibiotics for Appendicitis.

Kronman MP1, Oron AP2, Ross RK3, Hersh AL4, Newland JG5, Goldin A6, Rangel SJ7, Weissman SJ8, Zerr DM9, Gerber JS3.

Author information:

1Division of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, Washington; Center for Clinical and Translational Research, and matthew.kronman@seattlechildrens.org.

2Center for Clinical and Translational Research, and.

3Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;

4Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah;

5Division of Infectious Diseases, Children's Mercy Hospitals and Clinics, Kansas City, Missouri;

6Department of Pediatric Surgery, University of Washington, Seattle, Washington; and.

7Department of Pediatric Surgery, Harvard Medical School, Boston, Massachusetts.

8Division of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, Washington; Center for Global Infectious Diseases Research, Seattle Children's Hospital Research Institute, Seattle, Washington;

9Division of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, Washington; Center for Clinical and Translational Research, and.

Abstract

BACKGROUND AND OBJECTIVES:

Appendicitis guidelines recommend either narrower- or extended-spectrum antibiotics for treatment of complicated appendicitis. The goal of this study was to compare the effectiveness of extended-spectrum versus narrower-spectrum antibiotics for children with appendicitis.

METHODS:

We performed a retrospective cohort study of children aged 3 to 18 years discharged between 2011 and 2013 from 23 freestanding children's hospitals with an appendicitis diagnosis and appendectomy performed. Subjects were classified as having complicated appendicitis if they had a postoperative length of stay ≥3 days, a central venous catheter placed, major or severe illness classification, or ICU admission. The exposure of interest was receipt of systemic extended-spectrum antibiotics (piperacillin ± tazobactam, ticarcillin ± clavulanate, ceftazidime, cefepime, or a carbapenem) on the day of appendectomy or the day after. The primary outcome was 30-day readmission for wound infection or repeat abdominal surgery. Multivariable logistic regression, propensity score weighting, and subgroup analyses were used to control for confounding by indication.

RESULTS:

Of 24 984 patients, 17 654 (70.7%) had uncomplicated appendicitis and 7330 (29.3%) had complicated appendicitis. Overall, 664 (2.7%) patients experienced the primary outcome, 1.1% among uncomplicated cases and 6.4% among complicated cases (P < .001). Extended-spectrum antibiotic exposure was significantly associated with the primary outcome in complicated (adjusted odds ratio, 1.43 [95% confidence interval, 1.06 to 1.93]), but not uncomplicated, (adjusted odds ratio, 1.32 [95% confidence interval, 0.88 to 1.98]) appendicitis. These odds ratios remained consistent across additional analyses.

CONCLUSIONS:

Extended-spectrum antibiotics seem to offer no advantage over narrower-spectrum agents for children with surgically managed acute uncomplicated or complicated appendicitis.

Copyright © 2016 by the American Academy of Pediatrics.

PMID: 27354453 [PubMed - in process