• Yael Dreznik, Maya Paran, Efraim Bilavsky, Efrat Avinadav, and Dragan Kravarusic.
• Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
• Isr Med Assoc J. 2024 Jan 1; 26 (1): 303330-33.

BackgroundThe management of complicated appendicitis is inconclusive. Guidelines have not been established for the use of personalized antibiotic treatment.ObjectivesTo investigate specific risk factors to consider during the initial first-choice antibiotic therapy in children with complicated appendicitis.MethodsThis study included all pediatric patients younger than 18 years of age who underwent a laparoscopic appendectomy during 2012-2022 at a single tertiary medical center.ResultsIn total, 300 pediatric patients underwent laparoscopic appendectomy due to complicated appendicitis. The patients were treated with ceftriaxone + metronidazole (CM). For 57 (19%) patients, the empirical treatment was changed to tazobactam/piperacillin (TP) due to resistant bacteria or clinical deterioration. The presence of generalized peritonitis during surgery and C-reactive protein (CRP) levels above 20 mg/L at admission were identified as risk factors for changing the antibiotic regimen from CM to TP.ConclusionsGeneralized peritonitis and CRP > 20 gr/L were highly correlated with changing the antibiotic regimen to TP. For such patients, initial treatment with TP may result in clinical improvement and shorter hospitalization.

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