Antibiotics for Appendicectomy in Children and Adolescents During the Perioperative Period: An Integrative Review

Abstract

Objective: To analyze the preoperative use of antibiotics in children and adolescents requiring appendectomy.Data source: Integrative review was performed in the MEDLINE, Latin American and Caribbean Health Sciences (LILACS) and Cochrane databases and the PubMed portal, with no time limit. The keywords used were: appendicitis, child, adolescent and antibacterial with Boolean AND. The articles included were published in Portuguese, English or Spanish and whose participants were under 18 years of age. Review articles and guidelines were excluded. The studies were classified according to their level of evidence and 24 papers were selected.Data collection and analysis: Seven randomized clinical trial studies (level of evidence II), eight cohorts (level III), seven retrospective observational studies (level V) and two historical documentary analysis (level IV) were selected. The studies addressed antibiotics used in acute appendicitis in both uncomplicated and complicated cases. Antibiotics initiated in the preoperative period showed a decrease in the rates of surgical wound infections. First-line (empiric) regimens were tested for sensitivity to microorganisms in peritoneal material cultures, however the results were controversial. Broad-spectrum antibiotics have been suggested in some studies because they have good coverage, but in others they have not been recommended because of the risk of developing bacterial resistance. Shorter administration time and earlier change to the oral route reduced hospitalization time.Conclusions: There are several clinical protocols with different antibiotics. However, there is no standardization concerning the type of antibiotic drug, time of use, or route.

Management and Microbiology of Perforated Appendicitis in Pediatric Patients: A 5-Year Retrospective Study

“…While the choice of antibiotics varies by surgeon and across institutions, the overall duration and coverage spectrum for perforated appendicitis has become shorter and more specific. Previous studies have shown antibiotic therapy consisting of metronidazole and a third-generation cephalosporin to be effective in the management for perforated appendicitis, although “broad-spectrum” antibiotics continue to be routinely used [ 5 , 6 ]. Following surgery, postoperative complications are potentially worse among patients discharged home with intravenous antibiotics compared to oral antibiotics [ 7 – 9 ].…”

Analysis of intra-operative diagnosis and results of histological examination in children with acute appendicitis

“…Призначення антибактеріальної терапії та її тривалість у післяопераційному періоді переважно визначається формою гострого апендициту, яку первинно встановлює хірург при виділенні червоподібного відростка. При простих (катаральній) формах гострого апендициту можливе одноразове введення антибіотика перед втручанням, а ускладнені форми (флегмонозний, гангренозний та перфоративний) вимагають післяопераційної антибіотикотерапії [2,8], а її тривалість та тип антибіотика різниться у лікарнях [3,4]. За наявності гангренозного або перфоративного апендициту часто призначають комбінацію антибіотиків, які повинні впливати на грампозитивну, грамнегативну та анаеробну флору [2].…”

“…Водночас у 16 (2,3%) дітей, яким інтраопераційно встановлено діагноз гангренозного апендициту, при гістологічному дослідженні діагностований катаральний апендицит. Тоді як діагноз гангренозного замість флегмонозного апендициту не мав значного впливу на вибір антибактеріальної терапії, хоча у випадках флегмонозного апендициту можна було обмежитись введенням антибіотика (група цефалоспоринів) та метронідазолу, то у дітей із катаральним апендицитом післяопераційна антибіотикотерапія була недоцільною, що збігається з думкою багатьох дослідників [3,6,8].…”

Antibiotic Stewardship in Nonoperative Management of Perforated Appendicitis: Oral Antibiotics Are an Alternative

“…10,11 Previous studies have shown antibiotic therapy consisting of metronidazole and a third-generation cephalosporin to be effective in the management of perforated appendicitis, although "broad-spectrum" antibiotics including carbapenems are also often used. 12,13 Peripherally inserted central catheters (PICC lines) are commonly placed in children as part of the treatment algorithm for complicated appendicitis, one advantage of which is the ability to complete intravenous (IV) antibiotics as outpatients (OPAT). There are disadvantages to PICC lines, including painful insertion, activity restrictions, deep venous thrombosis, and risk of mechanical and infectious complications.…”