Postoperative antibiotic therapy for children with perforated appendicitis: long course of intravenous antibiotics versus early conversion to an oral regimen

Background: Although treatment for nonperforated acute appendicitis is usually straightforward, the optimal treatment of patients with perforated appendicitis remains controversial. Methods: Our institution performed a 2.5-year retrospective review of outcomes for postoperative treatment of perforated appendicitis. Patients were treated with either short-term intravenous (IV) antibiotic therapy and conversion to PO antibiotics (PO group) or long-term antibiotic therapy by way of a peripherally inserted central venous catheter (IV group). Results: One-hundred forty-nine patients with a diagnosis of perforated appendicitis were reviewed. There were 47 patients in the PO group and 102 patients in the. IV group. In the IV group, there were 2 intra-abdominal abscesses (2%) requiring readmission; there were also 2 intra-abdominal abscesses in the PO group (4.2%). Outpatient conversion to PO antibiotics resulted in an average savings of approximately $4,000/patient. Conclusions: Inpatient IV antibiotic therapy followed by outpatient conversion to PO antibiotics is a safe and cost-effective treatment of perforated appendicitis. (C) 2008 Excerpta Medica Inc. All rights reserved.