IMPPACT Trial: Is it safe to treat perforated appendicitis with monotherapy?
Topic overview
Prospective randomized trial of 162 pediatric patients demonstrates that postoperative monotherapy is superior to dual-drug therapy for perforated appendicitis, reducing intraabdominal abscess rates from 23.8% to 6.1% without increasing complications or antibiotic exposure duration.
Key takeaways
- Piperacillin-tazobactam monotherapy reduced intraabdominal abscess rates to 6.1% vs 23.8% with dual therapy (P=0.002) in perforated appendicitis.
- Monotherapy decreased postoperative CT imaging (13.9% vs 29.3%) and emergency department visits (8.8% vs 26.4%) compared to combination therapy.
- Antibiotic-related complications and treatment duration were equivalent between monotherapy and dual-drug regimens.
- Dual-drug therapy was the strongest predictor of IAA formation (OR 9.21) on multivariate analysis.
- Strict perforation definition (visible hole or intraabdominal fecalith) ensured study population homogeneity in this multicenter RCT.
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