Extended-spectrum antibiotics unnecessary in kids with appendicitis

Last Updated: 2016-06-28

By Reuters Staff

NEW YORK (Reuters Health) - Extended-spectrum antibiotics aren't better than narrower-spectrum agents for children with acute uncomplicated or complicated appendicitis, new research suggests.

In looking back at nearly 25,000 children with appendicitis across 23 children's hospitals, the researchers found that use of empiric extended-spectrum antibiotics was not associated with improved outcomes. And in the subgroup with complicated appendicitis, use of empiric extended-spectrum antibiotics was associated with treatment failure.

Current appendicitis guidelines call for either narrower- or extended-spectrum antibiotics for treatment of complicated appendicitis, Dr. Matthew Kronman of the University of Washington in Seattle and colleagues note in their report online June 28 in Pediatrics.

They compared the effectiveness of extended-spectrum (piperacillin ± tazobactam, ticarcillin ± clavulanate, ceftazidime, cefepime, or a carbapenem) versus narrower-spectrum antibiotics for children aged 3 to 18 with appendicitis who had appendectomy.

Of 24,984 patients, 17,654 (71%) had uncomplicated appendicitis and 7,330 (29%) had complicated appendicitis. Overall, 664 (2.7%) patients were readmitted for wound infection or repeat abdominal surgery within 30 days (the primary outcome). This occurred in about one percent of uncomplicated cases and about 6% of complicated cases.

Exposure to extended-spectrum antibiotics was significantly associated with the primary outcome in complicated (adjusted odds ratio 1.43) but not uncomplicated cases (aOR 1.32).

Dr. Kronman and colleagues say their observations have implications for antimicrobial stewardship. "The optimal antibiotic management of appendicitis remains undefined; some single-agent, extended-spectrum regimens are associated with shorter LOS (length of stay) and lower hospital charges. However, avoiding extended-spectrum antibiotics is preferable when possible, due both to increased cost and the association between their use and development of antibiotic-resistant infections. Furthermore, appendicitis is a top contributor to antibiotic use in hospitalized children," they write.

"Local guidelines," they add, "have successfully standardized appendicitis care, suggesting that antimicrobial stewardship programs could support selecting narrower-spectrum antibiotics for children with appendicitis (and particularly uncomplicated appendicitis) whenever appropriate."

The study had no commercial funding and the authors have no relevant disclosures.

SOURCE: http://bit.ly/291htCK

Pediatrics 2016.