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Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg 2010 Nov;45(11):2181-5

Date

11/03/2010

Pubmed ID

21034941

DOI

10.1016/j.jpedsurg.2010.06.038

Scopus ID

2-s2.0-78049460433 (requires institutional sign-in at Scopus site)   112 Citations

Abstract

OBJECTIVE: The aim of the study was to review evidence-based data regarding the use of antibiotics for the treatment of appendicitis in children.

DATA SOURCE: Data were obtained from PubMed, MEDLINE, and citation review.

STUDY SELECTION: We conducted a literature search using "appendicitis" combined with "antibiotics" with children as the target patient population. Studies were selected based on relevance for the following questions: (1) What perioperative antibiotics should be used for pediatric patients with nonperforated appendicitis? (2) For patients with perforated appendicitis treated with appendectomy: a. What perioperative intravenous antibiotics should be used? b. How long should perioperative intravenous antibiotics be used? c. Should oral antibiotics be used? (3) For patients with perforated appendicitis treated with initial nonoperative management, what antibiotics should be used in the initial management?

RESULTS: Children with nonperforated appendicitis should receive preoperative, broad-spectrum antibiotics. In children with perforated appendicitis who had undergone appendectomy, intravenous antibiotic duration should be based on clinical criteria. Furthermore, broad-spectrum, single, or double agent therapy is as equally efficacious as but is more cost-effective than triple agent therapy. If intravenous antibiotics are administered for less than 5 days, oral antibiotics should be administered for a total antibiotic course of 7 days. For children with perforated appendicitis who did not initially undergo an appendectomy, the duration of broad-spectrum, intravenous antibiotics should be based on clinical symptoms.

CONCLUSIONS: Current evidence supports the use of guidelines as described above for antibiotic therapy in children with acute and perforated appendicitis.

Author List

Lee SL, Islam S, Cassidy LD, Abdullah F, Arca MJ, 2010 American Pediatric Surgical Association Outcomes and Clinical Trials Committee

Author

Laura Cassidy PhD Associate Dean, Director, Professor in the Institute for Health and Equity department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Acute Disease
Anti-Bacterial Agents
Appendicitis
Child
Dose-Response Relationship, Drug
Humans
Incidence
Injections, Intravenous
Treatment Outcome