Prospective evaluation of a clinical response directed pathway for complicated appendicitis
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Dec 2018 · 1 min read
In brief
In brief
UK pediatric surgery team prospectively evaluated a response-directed pathway that reduced mandatory IV antibiotics from 5 to 3 days for complicated appendicitis, with oral antibiotics only given for elevated white blood cell counts. The pathway tailored antibiotic duration to clinical markers (fever resolution, oral tolerance) rather than fixed protocols.
Written by the GCMD Library team from the article.
Aim
Despite evidence to suggest shorter durations of antibiotics are safe in complicated appendicitis, the practice has not been widely adopted in the UK. Our aim was to determine whether a clinical pathway that tailors antibiotics to clinical condition was safe and effective.
Methods
A new post-operative pathway (NewPath) was devised that reduced mandatory intravenous antibiotics for complicated appendicitis (perforated or gangrenous) from 5 to 3 days post-operatively, provided the child was apyrexial for >12 h and tolerating oral diet. Oral antibiotics were only given if white-blood-cell counts were raised. Data were collected prospectively (NewPath) and compared to 100 cases immediately prior. Data are presented as median [IQR]. Comparisons used the Fisher's exact or Mann Whitney U tests as appropriate. Significance was defined as p