Evaluation of the Antibiotic Use for Surgical Prophylaxis in Paediatric Acute Appendicitis

Introduction: The aim was to evaluate antibiotic use for surgical prophylaxis in paediatric acute appendicitis before and after introduction of the hospital guidelines. Materials and Methods: Retrospective – observational study of antibiotic use in 68 patients with acute appendicitis in the Paediatric Surgery clinic at the University Children Hospital. Duration of this study was four months: July/August and November/December 2013. All data, such as patients’ demographic details, information on antibiotic use and surgery, were collected from the patients’ medical records. Results: Total number of patients: 30 in July/August and 38 in November/December. Surgery had 28 (93.3%) patients in July/August, 33 (86.8%) in November/ December. 2 patients in July/August and 5 in November/December were treated with ampicillin and gentamicin. 2 (8.7%) patients received a single dose in July/August, 4 (12.9%) in November/December; receiving multiple doses within 24h: 1 (4.3%) patient in July/August, 2 (6.5%) in November/December; prophylaxis >1 day: 20 (87%) patients in July/August, 25 (80.6%) in November/December. Prophylaxis was too early in 7 (30.4%) patients in July/August, 9 (29%) in November/ December; on time: 2 (8.7%) in July/August and 8 (25.8%) in November/December, too late: 12 (25.2%) in July/August, 14 (45.2%) in November/December. One (3.2%) patient in November/December received antibiotics in accordance with the guidelines. Conclusion: Although the guidelines were discussed and accepted by surgeons and there was two month introduction period as well, only few positive trends were observed with the antibiotic treatment guidelines not having major impact on antibiotic use. There is a need for new ways of promoting adherence to the guidelines and appropriate antibiotic use.

Key words: Acute appendicitis, antibiotic guidelines, hospitalized children, surgical prophylaxis.