Comparison of Monotherapy with Piperacillin/Tazobactam Versus Multidrug Therapy for Treatment of Perforated Appendix in Children
Monotherapy vs. Multidrug Therapy for Perforated Appendix in Children
DOI:
https://doi.org/10.61919/jhrr.v4i3.1591Keywords:
Pediatric appendicitis, perforated appendix, piperacillin/tazobactam, ceftriaxone, metronidazole, antibiotic therapy, surgical outcomes, pediatric surgery.Abstract
Background: Appendicitis is the most common surgical emergency in pediatric patients, with perforated appendicitis posing significant risks due to postoperative complications. The optimal antibiotic regimen to manage these risks remains debated.
Objective: To compare the efficacy of piperacillin/tazobactam monotherapy versus ceftriaxone and metronidazole multi-drug therapy in children undergoing open appendectomy for perforated appendicitis.
Methods: This randomized study included 74 pediatric patients (aged 4-13 years) diagnosed with perforated appendicitis at the Pediatric Surgery Department, Mayo Hospital, between December 2023 and June 2024. Patients were randomized into two groups: Group A received piperacillin/tazobactam monotherapy, and Group B received ceftriaxone and metronidazole. The primary outcomes were surgical site infections (SSI), intra-abdominal collections, and hospital stay. Data were analyzed using SPSS version 25, with significance set at p≤0.05.
Results: Intra-abdominal collection occurred in 2 patients (5.4%) in Group A and 3 patients (8.1%) in Group B (p=0.643). SSI rates were 13.5% in Group A and 10.8% in Group B (p=0.722). The mean hospital stay was significantly shorter in Group B (7.16±0.727 days) compared to Group A (7.92±0.829 days, p<0.05).
Conclusion: Monotherapy with piperacillin/tazobactam demonstrated comparable effectiveness to multi-drug therapy, but multi-drug therapy resulted in a shorter hospital stay.
Downloads
References
Miyauchi H, Okata Y, Hatakeyama T, Nakatani T, Nakai Y, Bitoh Y. Analysis of Predictive Factors for Perforated Appendicitis in Children. Pediatr Int. 2020;62(6):711-5.
Demetrashvili Z, Kenchadze G, Pipia I, Khutsishvili K, Loladze D, Ekaladze E, et al. Comparison of Treatment Methods of Appendiceal Mass and Abscess: A Prospective Cohort Study. Ann Med Surg. 2019;48:48-52.
Kumar P, Bhatia SK. Post-Operative Antibiotics After Appendectomy in Non-Perforated Appendicitis: A Clinical Study. Int J Surg. 2018;2(1):40-2.
Malia L, Sturm JJ, Smith SR, Brown RT, Campbell B, Chicaiza H. Predictors for Acute Appendicitis in Children. Pediatr Emerg Care. 2021;37(12):962-8.
Akbulut S, Koç C, Şahin TT, Şahin E, Tuncer A, Demyati K, et al. An Investigation Into the Factors Predicting Acute Appendicitis and Perforated Appendicitis. Turkish J Trauma Emerg Surg. 2021;27(4):150-5.
Islam AM, Akhter N, Imam MZ, Rahman M, Rumi JU. Efficacy of Local Use of Metronidazole Solution Among Acute Appendicitis Patients for the Prevention of Wound Infection After Appendectomy: A Randomized Control Trial. J Natl Inst Neurosci Bangladesh. 2020;6(1):54-8.
Takesue Y, Kusachi S, Mikamo H, Sato J, Watanabe A, Kiyota H, et al. Antimicrobial Susceptibility of Common Pathogens Isolated From Postoperative Intra-Abdominal Infections in Japan. J Infect Chemother. 2018;24(5):330-40.
Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and Treatment of Acute Appendicitis: 2020 Update of the WSES Jerusalem Guidelines. World J Emerg Surg. 2020;15(1):27.
Gordon AJ, Choi JH, Ginsburg H, Kuenzler K, Fisher J, Tomita S. Oral Antibiotics and Abscess Formation After Appendectomy for Perforated Appendicitis in Children. J Surg Res. 2020;256:56-60.
He K, Rangel SJ. Advances in the Diagnosis and Management of Appendicitis in Children. Adv Surg. 2021;55:9-33.
Howell EC, Dubina ED, Lee SL. Perforation Risk in Pediatric Appendicitis: Assessment and Management. Pediatr Health Med Ther. 2018;9:135-45.
Hassan ME. Monotherapy Versus Triple Therapy Antibiotics for the Management of Perforated Appendicitis in Children. Ain Shams J Surg. 2014;7(1):1-6.
Goldin AB, Sawin RS, Garrison MM, Zerr DM, Christakis DA. Aminoglycoside-Based Triple-Antibiotic Therapy Versus Monotherapy for Children With Ruptured Appendicitis. Pediatrics. 2007;119(5):905-11.
Chen C, Botelho C, Cooper A, Hibberd P, Parsons SK. Current Practice Patterns in the Treatment of Perforated Appendicitis in Children. J Am Coll Surg. 2003;196(2):212-21.
Nadler EP, Reblock KK, Ford HR, Gaines BA. Monotherapy Versus Multi-Drug Therapy for the Treatment of Perforated Appendicitis in Children. Surg Infect. 2003;4(4):327-33.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Nadir Aman, Muhammad Sharif, Mariam Rafique, Mahwish Noor ul Haq, Zuha, Ubaid
This work is licensed under a Creative Commons Attribution 4.0 International License.
Public Licensing Terms
This work is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). Under this license:
- You are free to share (copy and redistribute the material in any medium or format) and adapt (remix, transform, and build upon the material) for any purpose, including commercial use.
- Attribution must be given to the original author(s) and source in a manner that is reasonable and does not imply endorsement.
- No additional restrictions may be applied that conflict with the terms of this license.
For more details, visit: https://creativecommons.org/licenses/by/4.0/.
