Postoperative antibiotic therapy for children with perforated appendicitis: long course of intravenous antibiotics versus early conversion to an oral regimen

Am J Surg. 2008 Feb;195(2):141-3. doi: 10.1016/j.amjsurg.2007.10.002.


Background: Although treatment for nonperforated acute appendicitis is usually straightforward, the optimal treatment of patients with perforated appendicitis remains controversial.

Methods: Our institution performed a 2.5-year retrospective review of outcomes for postoperative treatment of perforated appendicitis. Patients were treated with either short-term intravenous (IV) antibiotic therapy and conversion to PO antibiotics (PO group) or long-term antibiotic therapy by way of a peripherally inserted central venous catheter (IV group).

Results: One-hundred forty-nine patients with a diagnosis of perforated appendicitis were reviewed. There were 47 patients in the PO group and 102 patients in the IV group. In the IV group, there were 2 intra-abdominal abscesses (2%) requiring readmission; there were also 2 intra-abdominal abscesses in the PO group (4.2%). Outpatient conversion to PO antibiotics resulted in an average savings of approximately $4,000/patient.

Conclusions: Inpatient IV antibiotic therapy followed by outpatient conversion to PO antibiotics is a safe and cost-effective treatment of perforated appendicitis.

Publication types

  • Comparative Study

MeSH terms

  • Administration, Oral
  • Anti-Bacterial Agents / administration & dosage*
  • Appendectomy / methods
  • Appendicitis / diagnosis
  • Appendicitis / drug therapy*
  • Appendicitis / surgery*
  • Child
  • Child, Preschool
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Infusions, Intravenous
  • Length of Stay
  • Male
  • Postoperative Care / methods
  • Probability
  • Retrospective Studies
  • Risk Assessment
  • Treatment Outcome


  • Anti-Bacterial Agents