Results of a pilot trial comparing prolonged intravenous antibiotics with sequential intravenous/oral antibiotics for children with perforated appendicitis

Henry E. Rice, Rebecca L. Brown, Gerald Gollin, Michael G. Caty, James Gilbert, Michael A. Skinner, Philip L. Glick, Richard G. Azizkhan

Research output: Contribution to journalArticle

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Abstract

Hypothesis: For children with perforated appendicitis, the use of a prolonged course of intravenous (IV) antibiotics is equivalent to a short course of IV antibiotics followed by sequential conversion to oral (PO) antibiotics. Design: Prospective, randomized, clinical trial. Setting: Multicenter study in tertiary children's hospitals. Patients: Children (aged 5-18 years) with perforated appendicitis found at laparotomy. Intervention: Children were randomized after appendectomy either to a 10-day course of a combination of IV ampicillin, gentamicin sulfate, and clindamycin (n= 10); or to a short course of a combination of IV ampicillin, gentamicin, and clindamycin, followed by conversion to a combination of PO amoxicillin and clavulanate potassium plus metronidazole (n = 16). Main Outcome Measures: The primary outcome measure was clinical success, which was rated as complete, partial, or failure. Secondary outcome measures included return of oral intake, duration of fever, return of normal white blood cell count, and patient charges. Treatment equivalence was determined using confidence interval analysis. Results: We found treatment equivalence between the IV and IV/PO groups, with 6 (60%) complete and 4 (40%) partial successes for the 10 patients in the IV group and 15 (94%) complete and 1 (6%) partial successes for the 16 patients in the IV/PO group (P≤.05). There was no difference in return of oral intake, duration of fever, or return of normal white blood cell count between the groups. Conversion to oral therapy results in savings of approximately $1500 per case. Conclusion: There is treatment equivalence between prolonged IV therapy and IV therapy followed by conversion to oral antibiotic therapy in children with perforated appendicitis.

Original languageEnglish (US)
Pages (from-to)1391-1395
Number of pages5
JournalArchives of Surgery
Volume136
Issue number12
StatePublished - 2001

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Appendicitis
Anti-Bacterial Agents
Clindamycin
Outcome Assessment (Health Care)
Ampicillin
Gentamicins
Leukocyte Count
Therapeutics
Fever
Amoxicillin-Potassium Clavulanate Combination
Appendectomy
Metronidazole
Tertiary Care Centers
Laparotomy
Multicenter Studies
Randomized Controlled Trials
Confidence Intervals

ASJC Scopus subject areas

  • Surgery

Cite this

Rice, H. E., Brown, R. L., Gollin, G., Caty, M. G., Gilbert, J., Skinner, M. A., ... Azizkhan, R. G. (2001). Results of a pilot trial comparing prolonged intravenous antibiotics with sequential intravenous/oral antibiotics for children with perforated appendicitis. Archives of Surgery, 136(12), 1391-1395.

Results of a pilot trial comparing prolonged intravenous antibiotics with sequential intravenous/oral antibiotics for children with perforated appendicitis. / Rice, Henry E.; Brown, Rebecca L.; Gollin, Gerald; Caty, Michael G.; Gilbert, James; Skinner, Michael A.; Glick, Philip L.; Azizkhan, Richard G.

In: Archives of Surgery, Vol. 136, No. 12, 2001, p. 1391-1395.

Research output: Contribution to journalArticle

Rice, HE, Brown, RL, Gollin, G, Caty, MG, Gilbert, J, Skinner, MA, Glick, PL & Azizkhan, RG 2001, 'Results of a pilot trial comparing prolonged intravenous antibiotics with sequential intravenous/oral antibiotics for children with perforated appendicitis', Archives of Surgery, vol. 136, no. 12, pp. 1391-1395.
Rice, Henry E. ; Brown, Rebecca L. ; Gollin, Gerald ; Caty, Michael G. ; Gilbert, James ; Skinner, Michael A. ; Glick, Philip L. ; Azizkhan, Richard G. / Results of a pilot trial comparing prolonged intravenous antibiotics with sequential intravenous/oral antibiotics for children with perforated appendicitis. In: Archives of Surgery. 2001 ; Vol. 136, No. 12. pp. 1391-1395.
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abstract = "Hypothesis: For children with perforated appendicitis, the use of a prolonged course of intravenous (IV) antibiotics is equivalent to a short course of IV antibiotics followed by sequential conversion to oral (PO) antibiotics. Design: Prospective, randomized, clinical trial. Setting: Multicenter study in tertiary children's hospitals. Patients: Children (aged 5-18 years) with perforated appendicitis found at laparotomy. Intervention: Children were randomized after appendectomy either to a 10-day course of a combination of IV ampicillin, gentamicin sulfate, and clindamycin (n= 10); or to a short course of a combination of IV ampicillin, gentamicin, and clindamycin, followed by conversion to a combination of PO amoxicillin and clavulanate potassium plus metronidazole (n = 16). Main Outcome Measures: The primary outcome measure was clinical success, which was rated as complete, partial, or failure. Secondary outcome measures included return of oral intake, duration of fever, return of normal white blood cell count, and patient charges. Treatment equivalence was determined using confidence interval analysis. Results: We found treatment equivalence between the IV and IV/PO groups, with 6 (60{\%}) complete and 4 (40{\%}) partial successes for the 10 patients in the IV group and 15 (94{\%}) complete and 1 (6{\%}) partial successes for the 16 patients in the IV/PO group (P≤.05). There was no difference in return of oral intake, duration of fever, or return of normal white blood cell count between the groups. Conversion to oral therapy results in savings of approximately $1500 per case. Conclusion: There is treatment equivalence between prolonged IV therapy and IV therapy followed by conversion to oral antibiotic therapy in children with perforated appendicitis.",
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