Aim Acute appendicitis is the leading cause of emergency abdominal surgery in the paediatric population with 2508 cases presenting to our surgery department between 2002–2012. The purpose of this study was to audit the management of acute appendicitis in children compared to local and national protocol.
Method Surgical consultants and trainees answered a questionnaire on their typical antibiotic regimen for acute appendicitis. Their responses were compared to the local and national protocols for Empirical Antibiotic Prescribing for Children.
Results Even though local protocols exist, none are being followed. IV Cefotaxime + IV Metronidazole are the antibiotics of choice for all surgeons, however regimen durations show considerable variations. Normal appendix: none (5), 1 dose (1), 2 doses (4), 3 doses (4) 24 hrs (1). Inflamed appendix: 2 doses (7), 3 doses (6), 24hrs IV (2). Gangrenous appendix: 2 doses (3), 3 doses (4), 24hrs IV (2), up to 5 days (1) 5 days (4), 5–7 days +/-gentamicin/amoxicillin (1). Localised peritonitis: 2 doses (1), 3 doses (1), 24 h (1) 48 h (3), up to 5 days (1) 5 days (5), 5 days +/- iv gentamicin (2), 5–7 days +/-gentamicin/amoxicillin (1). Generalised peritonitis: 3–5 days +/- gentamicin (1), 5 days (10), 5days +/- gentamicin (3), 5–7 days +/- gentamicin/amoxicillin (1). There are differing opinions on peritoneal swabs, as well as the clinical advantage of taking cultures. 7 surgeons always take peritoneal swabs for culture, 4 will take cultures if there is free fluid or pus, and 4 never take swabs. Peritoneal culture results alone rarely influence antibiotic choice. More importance is placed on clinical condition and appendix pathology. If there is free fluid, pus, a perforation or peritonitis, a washout containing antibiotics is always performed.
Conclusion Antibiotic management varies between surgeons despite the recommended IV Amoxicillin+ IV Gentamicin+ IV Metronidazole for empirical treatment of intra-abdominal sepsis. A clinical pathway is needed to level out inconsistencies in appendicitis management. There are no SIGN/NICE guidelines at present for acute appendicitis, therefore a clinical management pathway specific to paediatrics needs to be initiated and existing local guidelines need updating in line with antibiotic resistance and common practice.
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