Subscribe to RSS
DOI: 10.1055/s-0032-1320016
Current Management of Complicated Appendicitis in Children
Publication History
Publication Date:
05 July 2012 (online)
![](https://www.thieme-connect.de/media/ejps/201203/lookinside/thumbnails/10.1055-s-0032-1320016-1.jpg)
Abstract
The optimal management for children with complicated appendicitis remains unclear. However, our group has been interested in this disease, and has initiated several prospective randomized trials looking at various aspects of the care of these patients. In this article, we will discuss our definition of perforated appendicitis and how it was derived. We will also discuss a prospective randomized trial looking at the optimal antibiotic regimen and its relative place in the literature as well the data we have generated on the length of antibiotic therapy. We will also review the available data on the timing and necessity of appendectomy for perforated appendicitis. Finally, we will discuss the management of the difficult subset of patients who present with a well-defined abscess.
-
References
- 1 Ponsky TA, Hafi M, Heiss K, Dinsmore J, Newman KD, Gilbert J. Interobserver variation in the assessment of appendiceal perforation. J Laparoendosc Adv Surg Tech A 2009; 19 (Suppl 1) S15-S18
- 2 St Peter SD, Tsao K, Spilde TL , et al. Single daily dosing ceftriaxone and metronidazole vs standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomized trial. J Pediatr Surg 2008; 43 (6) 981-985
- 3 Fraser JD, Aguayo P, Leys CM , et al. A complete course of intravenous antibiotics vs a combination of intravenous and oral antibiotics for perforated appendicitis in children: a prospective, randomized trial. J Pediatr Surg 2010; 45 (6) 1198-1202
- 4 St Peter SD, Sharp SW, Holcomb III GW, Ostlie DJ. An evidence-based definition for perforated appendicitis derived from a prospective randomized trial. J Pediatr Surg 2008; 43 (12) 2242-2245
- 5 Investigators of the Piperacillin/Tazobactam Intra-abdominal Infection Study Group. Results of the North American trial of piperacillin/tazobactam compared with clindamycin and gentamicin in the treatment of severe intra-abdominal infections. Eur J Surg Suppl 1994; 573 (573) 61-66
- 6 Nadler EP, Reblock KK, Ford HR, Gaines BA. Monotherapy versus multi-drug therapy for the treatment of perforated appendicitis in children. Surg Infect (Larchmt) 2003; 4 (4) 327-333
- 7 Maltezou HC, Nikolaidis P, Lebesii E, Dimitriou L, Androulakakis E, Kafetzis DA. Piperacillin/Tazobactam versus cefotaxime plus metronidazole for treatment of children with intra-abdominal infections requiring surgery. Eur J Clin Microbiol Infect Dis 2001; 20 (9) 643-646
- 8 Schmidt-Matthiesen A, Röding H, Windolf J , et al. A prospective, randomised comparison of single- vs. multiple-dose antibiotic prophylaxis in penetrating trauma. Chemotherapy 1999; 45 (5) 380-391
- 9 Roark MK, Reed Jr WE. Econotherapeutics. Diagn Microbiol Infect Dis 1995; 22 (1-2) 209-217
- 10 Paladino JA, Fong LD, Forrest A, Ramphal R. Cost effectiveness of cephalosporin monotherapy and aminoglycoside/ureidopenicillin combination therapy. For the treatment of febrile episodes in neutropenic patients. Pharmacoeconomics 2000; 18 (4) 369-381
- 11 Zoepf T, Jakobs R, Riemann JF. Ceftriaxone is twice as cost-effective as standard therapy in biliary tract infection. Hepatogastroenterology 2004; 51 (58) 941-945
- 12 Capri S, Dellamano R. Cost-effectiveness in the hospital use of antibiotics: introductory considerations. J Chemother 1993; 5 (5) 348-351
- 13 Castagnola E, Lanino E, Giacchino R, Viscoli C, Dini G. Strategies for cost-containment: once-daily ceftriaxone plus amikacin as empiric therapy for febrile granulocytopenic children with cancer. J Chemother 1999; 11 (1) 54-60
- 14 Pession A, Prete A, Paolucci G. Cost-effectiveness of ceftriaxone and amikacin as single daily dose for the empirical management of febrile granulocytopenic children with cancer. Chemotherapy 1997; 43 (5) 358-366
- 15 Charnas R, Lüthi AR, Ruch W ; Writing Committee for the International Collaboration on Antimicrobial Treatment of Febrile Neutropenia in Children. Once daily ceftriaxone plus amikacin vs. three times daily ceftazidime plus amikacin for treatment of febrile neutropenic children with cancer. Pediatr Infect Dis J 1997; 16 (4) 346-353
- 16 Davis R, Bryson HM. Ceftriaxone. A pharmacoeconomic evaluation of its use in the treatment of serious infections. Pharmacoeconomics 1994; 6 (3) 249-269
- 17 Smyth ET, Barr JG, O'Neill CA, Hogg GM. An assessment of the hidden and total antibiotic costs of four parenteral cephalosporins. Pharmacoeconomics 1995; 8 (6) 541-550
- 18 St Peter SD, Little DC, Calkins CM , et al. A simple and more cost-effective antibiotic regimen for perforated appendicitis. J Pediatr Surg 2006; 41 (5) 1020-1024
- 19 St Peter SD, Sharp SW, Ostlie DJ. Influence of histamine receptor antagonists on the outcome of perforated appendicitis: analysis from a prospective trial. Arch Surg 2010; 145 (2) 143-146
- 20 Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP. A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery 2010; 147 (6) 818-829
- 21 Blakely ML, Williams R, Dassinger MS , et al. Early vs interval appendectomy for children with perforated appendicitis. Arch Surg 2011; 146 (6) 660-665
- 22 Ein SH, Shandling B. Is interval appendectomy necessary after rupture of an appendiceal mass?. J Pediatr Surg 1996; 31 (6) 849-850
- 23 Puapong D, Lee SL, Haigh PI, Kaminski A, Liu IL, Applebaum H. Routine interval appendectomy in children is not indicated. J Pediatr Surg 2007; 42 (9) 1500-1503
- 24 Vons C, Barry C, Maitre S , et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet 2011; 377 (9777) 1573-1579
- 25 Janik JS, Ein SH, Shandling B, Simpson JS, Stephens CA. Nonsurgical management of appendiceal mass in late presenting children. J Pediatr Surg 1980; 15 (4) 574-576
- 26 Chen C, Botelho C, Cooper A, Hibberd P, Parsons SK. Current practice patterns in the treatment of perforated appendicitis in children. J Am Coll Surg 2003; 196 (2) 212-221
- 27 Muehlstedt SG, Pham TQ, Schmeling DJ. The management of pediatric appendicitis: a survey of North American Pediatric Surgeons. J Pediatr Surg 2004; 39 (6) 875-879 , discussion 875–879
- 28 Morrow SE, Newman KD. Current management of appendicitis. Semin Pediatr Surg 2007; 16 (1) 34-40
- 29 Owen A, Moore O, Marven S, Roberts J. Interval laparoscopic appendectomy in children. J Laparoendosc Adv Surg Tech A 2006; 16 (3) 308-311
- 30 Weiner DZ, Katz A, Hirschl RB , et al. Interval appendectomy in perforated appendicitis. Pediatr Surg Int 1995; 10: 82-85
- 31 Keckler SJ, Tsao K, Sharp SW, Ostlie DJ, Holcomb III GW, St Peter SD. Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess. J Pediatr Surg 2008; 43 (6) 977-980
- 32 St Peter SD, Aguayo P, Fraser JD , et al. Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial. J Pediatr Surg 2010; 45 (1) 236-240
- 33 Schurman JV, Cushing CC, Garey CL, Laituri CA, St Peter SD. Quality of life assessment between laparoscopic appendectomy at presentation and interval appendectomy for perforated appendicitis with abscess: analysis of a prospective randomized trial. J Pediatr Surg 2011; 46 (6) 1121-1125