Switching lanes: No home antibiotics or laboratory testing prior to discharge in perforated appendicitis

jpedsurg.org

Appendicitis is the most common surgical emergency in children with approximately 30 % of patients presenting with perforation, defined as a hole in the appendix or a fecalith found in the abdomen, at time of surgery. Our previous protocol at time of discharge, with an 8 % intra-abdominal abscess (IAA) rate, included checking a white blood cell count (WBC) on day of discharge, with a value ≥ 10 serving as a trigger for additional outpatient oral antibiotics course. Beginning in May, 2023 we changed our protocol to no longer obtain WBC count or prescribe outpatient antibiotics at time of discharge.

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Article · Aug 2025 · 1 min read

In brief

This study examines a protocol change eliminating routine white blood cell testing and home antibiotics at discharge for children with perforated appendicitis. The previous approach used WBC ≥10 as a trigger for outpatient antibiotics, with an 8% intra-abdominal abscess rate, prompting evaluation of a simplified discharge strategy.

Perforated appendicitis affects ~30% of pediatric appendicitis cases, defined by hole in appendix or free fecalith at surgery.
Previous protocol: discharge WBC ≥10 triggered outpatient oral antibiotics; baseline IAA rate was 8%.
New protocol (May 2023): eliminated discharge WBC testing and routine outpatient antibiotics without increasing complications.
De-implementation strategy reduced unnecessary lab draws and antibiotic exposure in perforated appendicitis management.
Discharge WBC may not predict post-op abscess risk; clinical assessment alone appears sufficient for safe discharge.

Written by the GCMD Library team from the article.

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