Post-discharge oral home antibiotic use in complicated pediatric appendicitis: a systematic review and meta-analysis

Ossai CR, Pu L, Kaelber D. Using aggregated data from 1.4 million pediatric patients to describe the epidemiology and demographic characteristics of appendicitis. Pediatrics. 2020;146:232–4.

Article  Google Scholar 

Omling E, Salö M, Saluja S, Bergbrant S, Olsson L, Persson A, et al. Nationwide study of appendicitis in children. Br J Surg. 2019;106:1623–31.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Georgeades C, Bodnar C, Bergner C, van Arendonk KJ. Association of complicated appendicitis with geographic and socioeconomic measures in children. Surgery. 2024;176:1475–84.

Article  PubMed  Google Scholar 

Michelson KA, Bucher BT, Neuman MI. Cost and late hospital care of publicly insured children after appendectomy. J Surg Res. 2024;297:41–6.

Article  PubMed  PubMed Central  Google Scholar 

Wang C, Li Y, Ji Y. Intravenous versus intravenous/oral antibiotics for perforated appendicitis in pediatric patients: a systematic review and meta-analysis. BMC Pediatr. 2019;19:407.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Lam JY, Beaudry P, Simms BA, Brindle ME. Impact of implementing a fast-track protocol and standardized guideline for the management of pediatric appendicitis. Can J Surg. 2021;64:E364–70.

Article  PubMed  PubMed Central  Google Scholar 

Muehlstedt SG, Pham TQ, Schmeling DJ. The management of pediatric appendicitis: a survey of North American pediatric surgeons. J Pediatr Surg. 2004;39:875–9.

Article  PubMed  Google Scholar 

Huttner B, Harbarth S. Antibiotics are not automatic anymore” —the French national campaign to cut antibiotic overuse. PLoS Med. 2009;6:e1000080.

Article  PubMed  PubMed Central  Google Scholar 

Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M, Boëlle PY, et al. Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002-2007. PLoS Med. 2009;6:e1000084.

Article  PubMed  PubMed Central  Google Scholar 

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

Article  PubMed  PubMed Central  Google Scholar 

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions version 6.5 (updated August 2024). Cochrane; 2024.

Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.

Article  PubMed  Google Scholar 

Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.

Article  PubMed  PubMed Central  Google Scholar 

Veroniki AA, Jackson D, Viechtbauer W, Bender R, Bowden J, Knapp G, et al. Methods to estimate the between-study variance and its uncertainty in meta-analysis. Res Synth Methods. 2016;7:55–79.

Article  PubMed  Google Scholar 

IntHout J, Ioannidis JP, Borm GF. The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. BMC Med Res Methodol. 2014;14:25.

Article  PubMed  PubMed Central  Google Scholar 

Röver C, Knapp G, Friede T. Hartung-Knapp-Sidik-Jonkman approach and its modification for random-effects meta-analysis with few studies. BMC Med Res Methodol. 2015;15:99.

Article  PubMed  PubMed Central  Google Scholar 

Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.

Article  CAS  PubMed  Google Scholar 

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Shi L, Lin L. The trim-and-fill method for publication bias: practical guidelines and recommendations based on a large database of meta-analyses. Medicine. 2019;98:e15987.

Article  PubMed  PubMed Central  Google Scholar 

Desai AA, Alemayehu H, Holcomb GW 3rd, St Peter SD. Safety of a new protocol decreasing antibiotic utilization after laparoscopic appendectomy for perforated appendicitis in children: a prospective observational study. J Pediatr Surg. 2015;50:912–4.

Article  PubMed  Google Scholar 

Anderson KT, Bartz-Kurycki MA, Kawaguchi AL, Austin MT, Holzmann-Pazgal G, Kao LS, et al. Home antibiotics at discharge for pediatric complicated appendicitis: friend or foe? J Am Coll Surg. 2018;227:247–54.

Article  PubMed  Google Scholar 

Bonasso PC, Dassinger MS, Wyrick DL, Smith SD, Burford JM. Evaluation of white blood cell count at time of discharge is associated with limited oral antibiotic therapy in children with complicated appendicitis. Am J Surg. 2019;217:1099–101.

Article  PubMed  Google Scholar 

Rossidis AC, Brown EG, Payton KJ, Mattei P. Implementation of an evidence-based protocol after appendectomy reduces unnecessary antibiotics. J Pediatr Surg. 2020;55:2379–86.

Article  PubMed  Google Scholar 

Ferguson DM, Parker TD, Arshad SA, Garcia EI, Hebballi NB, Tsao K. Standardized discharge antibiotics may reduce readmissions in pediatric perforated appendicitis. J Surg Res. 2020;255:388–95.

Article  PubMed  Google Scholar 

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.

Article  PubMed  Google Scholar 

Ketha B, Stephenson KJ, Dassinger MS, Smith SD, Burford JM. Eliminating use of home oral antibiotics in pediatric complicated appendicitis. J Surg Res. 2021;263:151–4.

Article  PubMed  Google Scholar 

Plattner AS, Newland JG, Wallendorf MJ, Shakhsheer BA. Management and microbiology of perforated appendicitis in pediatric patients: a 5-year retrospective study. Infect Dis Ther. 2021;10:2247–57.

Article  PubMed  PubMed Central  Google Scholar 

Anandalwar SP, Graham DA, Kashtan MA, Hills-Dunlap JL, Rangel SJ. Influence of oral antibiotics following discharge on organ space infections in children with complicated appendicitis. Ann Surg. 2021;273:821–5.

Article  PubMed  Google Scholar 

Jen J, Hwang R, Mattei P. Post-discharge antibiotics do not prevent intra-abdominal abscesses after appendectomy in children. J Pediatr Surg. 2023;58:258–62.

Article  PubMed  Google Scholar 

Morita K, Fujiogi M, Michihata N, Matsui H, Fushimi K, Yasunaga H, et al. Oral antibiotics and organ space infection after appendectomy and intravenous antibiotics therapy for complicated appendicitis in children. Eur J Pediatr Surg. 2023;33:74–80.

Article  PubMed  Google Scholar 

Theodorou CM, Lee SY, Lawrence Y, Saadai P, Hirose S, Brown EG. The utility of discharge antibiotics in pediatric perforated appendicitis without leukocytosis. J Surg Res. 2022;275:48–55.

Article  PubMed  PubMed Central  Google Scholar 

Russell KW, Skarda DE, Jones TW, Barnhart DC, Short SS. Cessation of antibiotics for complicated appendicitis at discharge does not increase risk of post-operative infection. J Pediatr Surg. 2024;59:91–5.

Article  PubMed  Google Scholar 

Patwardhan UM, Kahan A, Eldredge RS, Russell KW, Lee J, Short SS, et al. Comparison of postoperative antibiotic protocols for pediatric complicated appendicitis: a western pediatric surgery research consortium study. J Pediatr Surg. 2025;60:162165.

Article  PubMed  Google Scholar 

de Wijkerslooth EML, Boerma EG, van Rossem CC, van Rosmalen J, Baeten CIM, Beverdam FH, et al. 2 days versus 5 days of postoperative antibiotics for complex appendicitis: a pragmatic, open-label, multicentre, non-inferiority randomised trial. Lancet. 2023;401:366–76.

Comments (0)

No login
gif