Comparison of two antibiotic regimens in the treatment of perforated appendicitis in pediatric patients

Background and purpose: An increased incidence of post-surgical infectious complications in children admitted with a diagnosis of perforated appendici tis led to development of a disease-specific antibiogram and modification o f our post-operative antibiotic regimen. Methods: A historical control grou p comprised of 32 pediatric patients receiving ampicillin, gentamicin, and clindamycin (group AGC) was compared to a cohort of 32 children receiving t icarcillin/clavulanate plus gentamicin (group TG). The surgical procedure, peri-operative management, and inclusion, exclusion and discharge criteria were the same for each group. Outcome measures including length of stay, ti me to defervesce, incidence of infectious complications, and clinical failu res to the antibiotic regimen were compared. Results: The groups were simil ar with respect to gender, age, weight, surgical time, pre-operative leukoc ytes, and number of intra-operative bacterial isolates cultured per patient . Length of stay was 10.1 days in group TG and 12.5 days for group AGC (p = 0.0197). The number of clinical failures was reduced from 9 (28.1%) to 2 ( 6.3%) in group TG (p = 0.02). The time to defervesce was decreased by 1.4 d ays, and the number of infectious complications was reduced to 2.5-fold in group TG patients. Conclusions: Ticarcillin/clavulanate plus gentamicin was clinically more effective than ampicillin, gentamicin, and clindamycin com bination therapy in the management of perforated appendicitis in our pediat ric population.