In the setting of a perforated appendix, we are used to ordering antibiotics to reduce the risk of infectious complications from that perforation such as an appendiceal abscess. Yet what antibiotics are best—a broad spectrum combination or something more narrowly directed to the common bacteria in the abdomen? Kronman et al, (Extended- Versus Narrower-Spectrum Antibiotics for Appendicitis) share with us this week the results of their retrospective cohort study of children 3-18 years of age from 33 children’s hospitals who underwent an appendectomy.
Complications of the diseases or operation were defined as a postop stay over 3 days, a need for a central venous catheter, simply classifying the illness as major or severe, or requiring admission to a pediatric intensive care unit. The authors then compared extended versus narrow spectrum antibiotics focusing on 30-day readmission for wound infection or repeat surgery, while controlling for relevant confounders. Extended spectrum antibiotics resulted in a significant increase in readmissions in the first month post-op compared to narrow spectrum for children with complicated appendicitis but no difference was seen when compared to narrow spectrum in uncomplicated disease, thus suggesting no advantage of extended-spectrum over narrow-spectrum antimicrobials in treating this illness.
Is that your experience or do you find broad-spectrum antibiotic use in appendicitis prevents other complications not described as an outcome in this study? We welcome your thoughts by responding to this blog, posting an online comment on the study, or posting your ideas on our Facebook or Twitter page links.