There was no consistency among the protocol s regarding length of antibiotic use , discharge criteria , or use of home antibiotics following discharge .
Limiting duration of antibiotic use to3 days did not appear to be associated with higher rates of intraabdominal abscess or wound infection .
In the absence of higher-level evidence , shortening of antibiotic regimens following surgery for pediatric complicated appendicitis appears to be safe
The suitable duration of antibiotic use following appendectomy for advanced appendicitis in children is still debated .
Convalescent phase outpatient parenteral antiinfective therapy for children with complicated appendicitis.
BACKGROUND Children with a perforated or gangrenous appendix become clinical ly stable after medical and /or surgical therapy but often remain in the hospital solely to complete parenteral antibiotic therapy . This prospect i ve study investigates the outcomes when children who meet specified criteria are discharged to complete parenteral antibiotic therapy at home . METHODS Children age 1 to 17 years with appendicitis complicated by generalized peritonitis or intraabdominal abscess were eligible to participate . Subjects whose fever was decreasing , who were able to tolerate oral liquids and for whom further parenteral antibiotic therapy was deemed necessary were discharged from the hospital to receive outpatient parenteral antiinfective therapy ( OPAT ) with meropenem . Therapy was administered by a family member and supervised by home care nurses . Study personnel visited the home daily to collect data on adverse events , compliance and re source utilization . Pa tients served as their own controls in models of reduced hospitalization and net cost savings . RESULTS Discharged on average on the fourth postoperative day , 87 children received 4.5 + /- 2.1 days of OPAT . Six ( 7 % ) children were subsequently readmitted for complications including bowel obstruction ( 4 children ) , intraabdominal abscess ( 1 child ) and pleural effusion ( 1 child ) . Another child developed a viral syndrome during OPAT . All other patients recovered uneventfully . Six ( 7 % ) children discontinued meropenem prematurely because of rash ( 4 patients ) or diarrhea ( 2 patients ) . According to models in which each day of OPAT replaced a day of inpatient care , discharge to OPAT reduced hospitalization by 42 + /- 15 % and saved a median of $ 2908 ( 10th to 90th percentile range , $ 1,077 to $ 4,707 ) per patient . CONCLUSION Convalescent phase OPAT is a cost-effective alternative to continued hospitalization for children with complicated appendicitis who are clinical ly stable yet require further parenteral antibiotic therapy
There was no consistency among the protocol s regarding length of antibiotic use , discharge criteria , or use of home antibiotics following discharge .
Limiting duration of antibiotic use to3 days did not appear to be associated with higher rates of intraabdominal abscess or wound infection .
In the absence of higher-level evidence , shortening of antibiotic regimens following surgery for pediatric complicated appendicitis appears to be safe
The suitable duration of antibiotic use following appendectomy for advanced appendicitis in children is still debated .