Perforated Appendicitis in Children: Management, Microbiology, and Antibiotic Stewardship

Although appendicitis has been described for more than 300 years, its optimal management remains a topic of active investigation. Acute appendicitis is the most common cause of peritonitis in children, and rates of perforated appendicitis are much higher in children than in adults. Increased risk fo...

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Bibliographic Details
Published in:Paediatric drugs 2024-05, Vol.26 (3), p.277-286
Main Authors: Snyder, Katherine B., Hunter, Catherine J., Buonpane, Christie L.
Format: Article
Language:English
Subjects:
Abdomen
Abscesses
Age
Antibiotics
Appendectomy
Appendicitis
Clinical outcomes
Epidemiology
Gangrene
Health care access
Hospital costs
Infections
Internal Medicine
Length of stay
Medicine
Medicine & Public Health
Patients
Pediatrics
Peritonitis
Pharmacotherapy
Review Article
Risk factors
Surgeons
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Summary:Although appendicitis has been described for more than 300 years, its optimal management remains a topic of active investigation. Acute appendicitis is the most common cause of peritonitis in children, and rates of perforated appendicitis are much higher in children than in adults. Increased risk for perforated appendicitis in children is related to a delay in diagnosis due to age, size, access to care, and more. Surgical options include immediate appendectomy versus nonoperative management with intravenous antibiotics ± a drainage procedure, with a subsequent interval appendectomy. Microbiota of perforated appendicitis in children most often includes Escherichia coli , Bacteroides fragilis , Streptococcus , and more. Even though the most common organisms are known, there is a large variety of practice when it comes to postoperative antibiotic management in these patients. Studies discuss the benefits of mono- versus dual or triple therapy without a particular consensus regarding what to use. This is reflected across differing practices at various institutions. In this review, we aim to explore the implications of perforated appendicitis in pediatrics, common organisms seen, antibiotic regimen coverage, and the implications of variations of practice. Resistance to commonly used broad-spectrum antibiotics is evolving, therefore minimization of care variability is needed for improved patient outcomes and proper antibiotic stewardship.
ISSN:1174-5878
1179-2019
DOI:10.1007/s40272-024-00630-0