Abstract

Background and purpose: An increased incidence of post-surgical infectious complications in children admitted with a diagnosis of perforated appendicitis led to development of a disease-specific antibiogram and modification of our post-operative antibiotic regimen. Methods: A historical control group comprised of 32 pediatric patients receiving ampicillin, gentamicin, and clindamycin (group AGC) was compared to a cohort of 32 children receiving ticarcillin/ 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, time to defervesce, incidence of infectious complications, and clinical failures to the antibiotic regimen were compared. Results: The groups were similar with respect to gender, age, weight, surgical time, pre-operative leukocytes, 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 days, 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 combination therapy in the management of perforated appendicitis in our pediatric population.

Author Details

Authors

• J.C. Rodriguez¹
• D. Buckner²
• S. Schoenike¹
• O. Gomez-Marin³
• C. Oiticica²
• W.R. Thompson²

Departments

• ¹ Department of Pediatric Pharmacy Services, Jackson Children’s Hospital,
• ² Division of Pediatric Surgery, and
• ³ Departments of Epidemiology and Public Health and Pediatrics, University of Miami, Florida, USA

Address

Dr. J.C. Rodriguez; Jackson Memorial Hospital, Department of Pharmacy, 1611 NW 12th Avenue, Miami, Florida 33136, USA

Citation