[size=20px]A 12-year-old boy presents to the emergency department with right lower quadrant pain. His clinical history and imaging are consistent with perforated appendicitis, confirmed intraoperatively.

 

Based on the IMPPACT trial, which antibiotic regimen is associated with a decreased risk of intra-abdominal abscess formation in patients with perforated appendicitis?

 

A ampicillin, gentamicin, and clindamycin

 

B cefotaxime and metronidazole

 

C ceftriaxone and metronidazole

 

D piperacillin-tazobactam

 

E ciprofloxacin and metronidazole[/size]

D

correct answer

D piperacillin-tazobactam

 

A multi-institutional, prospective, randomized trial in children with perforated appendicitis compared two antibiotic regimens: monotherapy (piperacillin-tazobactam, PT) versus combination therapy (ceftriaxone and metronidazole, CM). The primary outcome was intra-abdominal abscess formation. Compared to the CM group, the PT group had a significantly lower intra-abdominal abscess rate [6.1% vs 23.8%, OR 4.80, P = 0.002]. Patients in the PT group also had a lower postoperative computed tomography imaging rate (13.9% vs 29.3%, OR 2.57, P = 0.030) and fewer emergency room visits (8.8% vs 26.4%, OR 3.73, P = 0.022). On multivariable logistic regression analysis, the use of CM versus PT (OR 9.21, P = 0.021) was found to be the most significant predictor for developing an intra-abdominal abscess.