Pediatric complicated appendicitis: Results of a standardized antibiotic protocol in a tertiary center.

BACKGROUND

At Geneva University Hospitals, the standard treatment for children with complicated appendicitis (CA) includes an appendectomy followed by intravenous antibiotics. Since 2013, the recommended first-line treatment is Ceftriaxone/Metronidazole (CM). If fever above 38.5 °C persists for 72 h postoperatively, a switch to Piperacillin/Tazobactam (PT) is advised. Currently, fever is the sole criterion for switching antibiotics.

AIMS: To identify predictive factors for switching from CM to PT and to evaluate the relevance of PT as a first-line treatment in this patient population, since upfront PT treatment may reduce hospital stay by up to three days.

METHODS

This retrospective study includes children aged 0-16 years treated for CA at our institution between 2013 and 2023 according to protocol. Two groups were compared: (1) patients who had required an antibiotic switch and (2) those who did not. Variables included demographics, medical history, biomarkers, imaging and surgical findings.

RESULTS

Among 256 patients (median age: 10 years, IQR: 7-13), 39 (15 %) required a switch. Multivariate logistic regression analysis showed a significant association between the switch and both high preoperative CRP levels (p = 0.021) and the presence of an intra-abdominal abscess (p < 0.001).

CONCLUSION

One in seven children with CA required an antibiotic switch. Elevated preoperative CRP levels and intra-abdominal abscess were significantly associated with the need for CM to PT switch. These patients may benefit from first-line PT treatment.