1Clinica Pediatrica, UOC di Chirurgia Pediatrica, SC di Farmacia e Nutrizione Parenterale, IRCCS Pediatrico “Burlo Garofolo”, Trieste
2UOC di Pediatria, Ospedale S. Antonio, San Daniele del Friuli (Udine)
3UOC di Pediatria, Azienda Ospedaliera S. Maria degli Angeli, Pordenone
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Key words: Appendicitis, Antimicrobial therapy, Children
Objective - To review evidence-based data regarding the use of antibiotics for the treatment
of appendicitis in children.
Methods - A literature search using “appendicitis” and “antibiotics” as key words and restricting target population to children (0-18) was carried out. Selected studies were analyzed to find answers to the following questions: 1) Should perioperative antibiotics be used for paediatric patients with nonperforated appendicitis? 2) Which perioperative antibiotic should be chosen? 3) Is it possible to treat children with nonperforated appendicitis with antibiotics solely? 4) For patients with perforated appendicitis treated with appendicectomy: a) Which intravenous antibiotics should be used? b) How long should intravenous antibiotics be used? c) Is it possible to shift to oral drugs?
Results - Children with nonperforated appendicitis must receive preoperative, broad-spectrum antibiotics, even if there is no univocal evidence about which regimen is the best. The sole use of antibiotics is not identified as an alternative to appendectomy in the management of acute appendicitis. In children with perforated appendicitis who had undergone appendicectomy, intravenous broad-spectrum, single, or double agent antibiotics is as equally efficacious as triple agent therapy. However, if intravenous antibiotics are administered properly, oral antibiotics are not necessary, but they could be administered to complete a total antibiotic course of 7 days. Intravenous therapy should be continued until the patient is afebrile and symptoms have resolved completely.
Conclusions - Current evidence supports using guidelines in the paediatric population for the antibiotic management of acute appendicitis, in order to uniform clinical approach to this problem.
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