Published online May 1, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. 905-911 (doi:10.1542/peds.2006-2040)
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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.




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