Antibiotics for Appendicitis: Is Broader Better?

Acute appendicitis, a common pediatric condition requiring hospitalization, sometimes requires an extended course of antibiotics for complicated disease. Guidelines for antibiotic selection vary, and some recommend broad-spectrum antibiotics to cover resistant gram-negative organisms, including Pseudomonas aeruginosa.

In a retrospective cohort study, investigators compared failure rates of extended-spectrum (e.g., piperacillin-tazobactam) versus narrow-spectrum (e.g., cefoxitin) antibiotic therapy in nearly 25,000 children aged 3–18 years hospitalized for complicated or uncomplicated appendicitis at 23 U.S. children's hospitals. Treatment failure was defined as 30-day readmission for a related condition. Multivariable analysis was used to control for the possibility that sicker children were more likely to receive broader-spectrum antibiotics.

Empiric broad-spectrum antibiotics were administered in 33% of children with uncomplicated appendicitis and 66% of children with complicated appendicitis. Treatment failure was 2.7% overall and was higher, as expected, in complicated versus uncomplicated disease (6.4% vs. 1.1%). Treatment failure was higher overall in children treated with extended-spectrum antibiotics, and this difference was statistically significant in those with complicated appendicitis (absolute risk difference, 1.9%).