Intravenous versus intravenous/oral antibiotics for perforated appendicitis in pediatric patients: a systematic review and meta-analysis.
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In brief
In brief
This systematic review and meta-analysis of 580 pediatric patients demonstrates that transitioning from intravenous to oral antibiotics after perforated appendicitis is noninferior to continued IV therapy alone. Sequential IV/PO treatment showed comparable rates of postoperative abscess, wound infection, and readmission while potentially reducing complications and costs associated with prolonged IV access.
Written by the GCMD Library team from the article.
BACKGROUND: The use of oral (PO) antibiotics following a course of certain intravenous (IV) antibiotics is proposed in order to avoid the complications of IV medications and to decrease the cost. However, the efficacy and safety of sequential IV/PO antibiotics is unclear and requires further study.
METHODS: The databases, including PubMed, EMBASE and Cochrane Library, were searched. Studies comparing outcomes in patients with perforated appendicitis receiving sequential IV/PO and PO antibiotics therapy were screened. The Newcastle-Ottawa Scale (NOS) and the Jadad score were used to evaluate the quality of the cohort and the randomized controlled portions of the trial, respectively. Statistical heterogeneity was assessed using the I2 value. A fixed or random-effect model was applied according to the I2 value.
RESULTS: Five controlled studies including a total of 580 patients were evaluated. The pooled estimates revealed that sequential IV/PO antibiotic therapy did not increase the risk of complications, with a risk ratio (RR) of 0.97 (95% CI 0.51-1.83, P = 0.93) for postoperative abscess, 1.04 (95% CI 0.25-4.36, P = 0.96) for wound infection and 0.62 (95% CI 0.33-1.16, P = 0.13) for readmission.
CONCLUSIONS: Our study demonstrates that sequential IV/PO antibiotic therapy is noninferior to IV antibiotic therapy regarding postoperative abscess, wound infection and readmission.
doi: 10.1186/s12887-019-1799-6.