Published online May 1, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. 905-911 (doi:10.1542/peds.2006-2040)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Goldin, A. B.
Right arrow Articles by Christakis, D. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Goldin, A. B.
Right arrow Articles by Christakis, D. A.
Related Collections
Right arrow Infectious Disease & Immunity
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Aminoglycoside-Based Triple-Antibiotic Therapy Versus Monotherapy for Children With Ruptured Appendicitis

Adam B. Goldin, MD, MPHa, Robert S. Sawin, MD, MSa, Michelle M. Garrison, PhDb, Danielle M. Zerr, MD, MPHc and Dimitri A. Christakis, MD, MPHd

a Departments of Pediatric General and Thoracic Surgery
c Pediatric Infectious Diseases
d Pediatrics, Children's Hospital and Regional Medical Center, Seattle, Washington
b Child Health Institute, University of Washington Medical Center, Seattle, Washington

OBJECTIVE. We conducted a retrospective cohort study to compare the use of triple therapy versus monotherapy for children and adolescents with perforated appendicitis and to determine whether there has been a transition to monotherapy within the freestanding children's hospitals that contribute to the Pediatric Health Information System database.

METHODS. We used the Pediatric Health Information System database, which includes billing and discharge data for 32 children's hospitals in the United States, to examine the trend in antibiotic usage and whether the postappendectomy antibiotic regimen was associated with differences in complication-related readmissions, length of stay, or charges in a population of children and adolescents with ruptured appendicitis and discharge dates between March 1, 1999, and September 30, 2004. Pairwise regression analyses were performed to compare the most common monotherapy regimens with the triple therapy.

RESULTS. A total of 8545 patients met the inclusion criteria, of whom 58%, over the entire study period, received the aminoglycoside-based triple antibiotic therapy on postoperative day 1. There was, however, a notable transition over this 6-year period, from 69% to 52% of surgeons using aminoglycoside-based combination therapy. There were no significant differences in the odds of readmission at 30 days except for the group receiving ceftriaxone, which was associated with significantly decreased odds. The subgroup receiving piperacillin/tazobactam monotherapy demonstrated significantly decreased length of stay (–0.90 days) and total hospital charges, and the group receiving cefoxitin demonstrated significantly decreased length of stay (–1.89 days), as well as decreased pharmacy and total hospital charges.

CONCLUSIONS. Single-agent antibiotic therapy in the treatment of perforated appendicitis is being used with increasing frequency, is at least equal in efficacy to the traditional aminoglycoside-based combination therapy, and may offer improvements in terms of length of stay, pharmacy charges, and hospital charges.

Key Words: appendicitis • antibiotics

Abbreviations: PHIS—Pediatric Health Information System • OR—odds ratio • CI—confidence interval • ICD-9—International Classification of Diseases, Ninth Revision • LOS—length of stay • ABT—aminoglycoside-based combination therapy

Accepted Jan 8, 2007.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 AAP NewsHome page
C. Kemp
Antibiotic monotherapy effective after ruptured appendicitis
AAP News, July 1, 2007; 28(7): 2 - 2.
[Full Text] [PDF]

Home page
 JWatch Infect. DiseasesHome page
The Best Antibiotic Treatment for Ruptured Appendicitis in Children?
Journal Watch Infectious Diseases, June 6, 2007; 2007(606): 7 - 7.
[Full Text]

Home page
 JWatch GeneralHome page
Changing Trend in Antibiotic Use for Appendicitis
Journal Watch (General), May 10, 2007; 2007(510): 3 - 3.
[Full Text]