The Strategy of a Shorter Course of Postoperative Intravenous Antibiotics for Advanced Appendicitis in Children

Objective: Antibiotic treatment is standard after appendectomy for advanced appendicitis in children with the aim to reduce postoperative complications. However, the evidence for deciding the duration of administration of the intravenous antibiotics (IVA) is limited. We present our experience focussing on the duration of IVA and the strategy for managing the complications. Methods: Retrospective review of patients undergoing an emergency appendectomy supervised by the senior surgeon (TT) over an 11-year period (2006-16) was done. Patient records were reviewed for operative findings, duration of IVA and oral antibiotics and post-operative complications. All patients diagnosed with advanced appendicitis were included. Post-operatively for the initial 3 days all received IVA viz. amoxicillin, metronidazole and gentamycin; continuing them further was based on the clinical course. The outcome and complications were analysed with respect to the duration of the (IVA) required. Results: 79 patients with advanced appendicitis were included in this study; 74 done laparoscopically and 5 open. There were 52 males and 27 females, with a mean age of 9.2 years (2.5-16). Median postoperative hospital stay was 4 days (3-24). 38 (48%) and 4 (5%) patients were able to stop IVA after 3 and 4 days respectively, the rest 37 (47%) required a longer course of IVA.15 were discharged home with oral antibiotics completing a total of 10 days antibiotics. The overall complications was 11.4%, wound infection in 4 patients and abscess in 5 .On statistical analysis, the higher incidence of complications in the 5 or more days IVA group was not significant comparing to those who received for shorter duration. Conclusion: In our experience children operated for advanced appendicitis early review and consideration of short course (minimum of 3 days) IV antibiotics based on clinical status is a safe and efficient method to treat with minimal complication rate