Triple Versus Double Antibiotic Therapy in Children Undergoing Laparoscopic Appendicectomy for Complicated Appendicitis: A Case–Control Study

<b><i>Background and Objectives:</i></b> Historically, a triple-antibiotic (TA) regimen (ampicillin, gentamicin, metronidazole) has been used for children with complicated appendicitis (CA) at our institution. We implemented a double-antibiotic (DA) regimen (ceftriaxone, metronidazole) in November 2018. The aim of this study was to compare the post-operative outcomes between the two groups. <b><i>Patients and Methods:</i></b> Clinical and laboratory data were collected from the medical records of children who underwent laparoscopic appendicectomy (LA) for CA between November 2017 and 2019. Data, reported as number of cases (%) and median with interquartile range or 95% confidence interval (CI), were analyzed with Fisher exact test and Mann-Whitney U test; p values <0.05 were considered significant. <b><i>Results:</i></b> One hundred and ninety-seven patients were identified; 99 treated with the TA regimen and 98 with the DA regimen. The groups had similar demographics. Post-operative complications were similar between the two groups: intra-abdominal abscess (IAA) 12 (12.1%) in TA versus 10 (10.2%) in DA (p = 0.82); surgical site infections 1 (1.0%) in TA versus 2 (2.2%) in DA (p = 0.62). Time to defervescence in the first 5 post-operative days was substantially longer in the TA group: 72 (95% CI 72-96) versus 48 (95% CI 48-72) hours (p = 0.003). Among patients without post-operative IAA, the DA group had a shorter post-operative hospital stay (5 [5-6] vs. 5.5 [5-6] days; p = 0.04). The cost of DA regimen was substantially lower (p < 0.0001). <b><i>Conclusions:</i></b> The DA regimen provided better post-operative temperature control and a quicker overall recovery, without increasing the incidence of IAA and surgical site infection in children following LA for CA.