COMMENTARY

Which Are Best in Appendicitis: Extended- or Narrow-Spectrum Antibiotics?

Albert B. Lowenfels, MD

Disclosures

September 19, 2018

For pediatric patients with uncomplicated appendicitis, what is the best choice of antibiotic therapy for preventing surgical-site infection and lowering the frequency of hospital revisits?

In a paper published in Annals of Surgery , the authors used the American College of Surgeons Pediatric National Surgical Quality Improvement Program (NSQIP-Pediatric) Appendectomy Pilot database along with a separate pediatric information database, which contained detailed information on antibiotic use.[1] They compared results in 908 children after either extended-spectrum (piperacillin/tazobactam) or narrow-spectrum (cefoxitin or ceftriaxone with metronidazole) antibiotic use in patients with similar baseline characteristics.

Overall, surgical-site infections were rare (n = 19), with no difference in frequency in either group (P = .936). Fifty-two patients had a postoperative visit either to the emergency department or were readmitted to the hospital, but again, there was no difference between prophylaxis with either an extended- or a narrow spectrum antibiotic.

The Bottom Line: Both Types of Antibiotics Were Equally Effective

Appendicitis is a common pediatric surgical abdominal emergency, but there is limited information about the comparative benefit of using a broad-spectrum versus a narrow-spectrum antibiotic. This report, which combines information from two separate pediatric databases, concluded that giving an extended-spectrum antibiotic had no advantage over a more limited-spectrum antibiotic.

It is an important issue, because widespread use of extended-spectrum antibiotics can lead to community bacterial resistance as well as having a deleterious impact on the patient's intestinal microflora. A surprising finding in this report is the wide hospital variation in hospital antibiotic use patterns: Some hospitals mainly used extended-spectrum antibiotics, whereas others preferred to use narrow-spectrum antibiotics. Furthermore, about one third of patients with uncomplicated appendicitis continued to receive antibiotics in the postoperative period, which is not recommended by current guidelines.

Bottom line: In regard to antibiotic use in children with uncomplicated appendicitis, narrow-spectrum antibiotics seem to be just as effective as extended-spectrum antibiotics.

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