Evaluation of white blood cell count at time of discharge is associated with limited oral antibiotic therapy in children with complicated appendicitis

Abstract

Background: Variation exists for postoperative antibiotics in children with complicated appendicitis. We investigated the impact of white blood count (WBC) at discharge on oral antibiotic therapy, abscess rate, and readmission rate.

Material/methods: We conducted a two year review of children with complicated appendicitis. In the pre-protocol group, total antibiotic therapy was ten days (IV and oral) and home oral antibiotics at discharge. In the post-protocol group, children with leukocytosis were prescribed oral antibiotics to complete seven days of total antibiotic therapy and children without leukocytosis were not prescribed oral home antibiotics.

Results: There was no difference between mean hospital days after operation (3.52 vs. 3.24, p = 0.5111), means days of inpatient intravenous antibiotics (3.13 vs. 2.58, p = 0.5438), post-operative abscess rates (20.7% vs. 19.6%, p = 0.9975), or readmission rate (13.4% vs. 12.4%, p = 1.000). The post-protocol group had a shorter average total antibiotic duration (4.24 vs. 9.52 days, p < 0.001) and were more likely to be discharged without oral antibiotics (71.1% vs 8.5%, p < 0.001).

Discussion: Limiting home antibiotics at discharge to children with leukocytosis significantly decreases home antibiotic use.

Keywords: Oral antibiotics; Perforated appendicitis; White blood count at discharge.