Pediatric surgery international · 2025
Piperacillin/tazobactam versus ceftriaxone/metronidazole for children with perforated appendicitis: a systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Armstrong Jennifer, Sriranjan Jhanahan, Briatico Daniel, Khan Sarah, Eltorki Mohamed, Livingston Michael H
Аннотация
PURPOSE: Most children with acute appendicitis are treated with laparoscopic appendectomy followed by antibiotics if the appendix is found to be perforated. There is variation in the type of post-operative antibiotics used for these patients.
METHODS: We conducted systematic searches of Medline, Embase, and Cochrane for comparative studies of children with perforated appendicitis treated with post-operative piperacillin/tazobactam versus ceftriaxone and metronidazole.
RESULTS: We identified four studies consisting of 25,730 children with perforated appendicitis treated with laparoscopic appendectomy followed by post-operative piperacillin/tazobactam (n = 9,950) or ceftriaxone and metronidazole (n = 15,780). One study was a randomized controlled trial (RCT) and three were multicenter observational studies. Meta-analysis suggested no differences between piperacillin/tazobactam and ceftriaxone and metronidazole in terms of deep/organ-space surgical site infection (risk ratio [RR] = 0.97, 95% confidence interval [CI] 0.57-1.65), post-operative imaging (RR = 0.99, 95% CI 0.71-1.37), return to the emergency department (RR = 0.82, 95% CI 0.50-1.37), and readmission to hospital (RR = 0.85, 95% CI 0.45-1.62). Heterogeneity between studies was substantial (I2 73-83%). The RCT was limited by possible ascertainment bias, while the three observational studies may have been affected by baseline differences between treatment groups.
CONCLUSION: This systematic review suggests that there is ongoing uncertainty regarding the optimal post-operative antibiotics for children with perforated appendicitis.
CLINICAL TRIAL REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023421492 .
METHODS: We conducted systematic searches of Medline, Embase, and Cochrane for comparative studies of children with perforated appendicitis treated with post-operative piperacillin/tazobactam versus ceftriaxone and metronidazole.
RESULTS: We identified four studies consisting of 25,730 children with perforated appendicitis treated with laparoscopic appendectomy followed by post-operative piperacillin/tazobactam (n = 9,950) or ceftriaxone and metronidazole (n = 15,780). One study was a randomized controlled trial (RCT) and three were multicenter observational studies. Meta-analysis suggested no differences between piperacillin/tazobactam and ceftriaxone and metronidazole in terms of deep/organ-space surgical site infection (risk ratio [RR] = 0.97, 95% confidence interval [CI] 0.57-1.65), post-operative imaging (RR = 0.99, 95% CI 0.71-1.37), return to the emergency department (RR = 0.82, 95% CI 0.50-1.37), and readmission to hospital (RR = 0.85, 95% CI 0.45-1.62). Heterogeneity between studies was substantial (I2 73-83%). The RCT was limited by possible ascertainment bias, while the three observational studies may have been affected by baseline differences between treatment groups.
CONCLUSION: This systematic review suggests that there is ongoing uncertainty regarding the optimal post-operative antibiotics for children with perforated appendicitis.
CLINICAL TRIAL REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023421492 .