Antibiotic stewardship in pediatric complicated appendicitis: Assessing the role of oral antibiotics after discharge

Purpose: To determine whether home oral antibiotic (OA) use after appendectomy for pediatric complicated appendicitis reduces post-discharge complications in patients who are afebrile prior to discharge. Methods: We queried the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) dataset for children aged 1–18 years who underwent appendectomy for complicated appendicitis between 2019 and 2023. Patients were included if they were afebrile and had no infective complications (i.e. fever, surgical site infections etc.) at discharge. All patients were stratified into age groups (ages 1–5, 5–10 and 10–18) and were subsequently grouped by whether they were prescribed home OA. The primary outcome measure was post-discharge intra-abdominal abscess (IAA). The relationship between home OA use and post-discharge outcomes was analyzed using multivariable logistic regression. Results: A total of 20,190 patients met criteria, with a median age of 10.0 years (IQR: 6.9–13.1). Approximately 70.9 % of patients received home OA and 29.1 % did not. Patient characteristics including age, preoperative WBC count, operative time, and length of stay appeared similar at baseline on unadjusted analysis. On multivariable analysis, home OA use did not reduce the odds of IAA in any age group (Age 1–5: aOR = 1.27, 95 % CI = 0.80–2.09; Age 5–10: aOR = 1.15, 95 % CI = 0.90–1.50; Age 10–18: aOR = 1.05, 95 % CI = 0.86–1.30). A subset analysis conducted for patients aged 5–18 years with intraoperative findings of perforated appendicitis also failed to identify any association between home OA use and post-discharge IAA (aOR = 1.09, 95 % C.I. = 0.92–1.29). Conclusion: There appears to be limited benefit to prescribing home OA for children with complicated appendicitis who are afebrile after appendectomy. Type of Study: Retrospective Cohort Study. Level of Evidence: Level III evidence.