Antibiotic Treatment in Complicated Appendicitis: Can It Be Optimized?

BACKGROUND

The management of complicated appendicitis is inconclusive. Guidelines have not been established for the use of personalized antibiotic treatment.

OBJECTIVES

To investigate specific risk factors to consider during the initial first-choice antibiotic therapy in children with complicated appendicitis.

METHODS

This study included all pediatric patients younger than 18 years of age who underwent a laparoscopic appendectomy during 2012-2022 at a single tertiary medical center.

RESULTS

In total, 300 pediatric patients underwent laparoscopic appendectomy due to complicated appendicitis. The patients were treated with ceftriaxone + metronidazole (CM). For 57 (19%) patients, the empirical treatment was changed to tazobactam/piperacillin (TP) due to resistant bacteria or clinical deterioration. The presence of generalized peritonitis during surgery and C-reactive protein (CRP) levels above 20 mg/L at admission were identified as risk factors for changing the antibiotic regimen from CM to TP.

CONCLUSIONS

Generalized peritonitis and CRP > 20 gr/L were highly correlated with changing the antibiotic regimen to TP. For such patients, initial treatment with TP may result in clinical improvement and shorter hospitalization.