Cefoxitin vs piperacillin/tazobactam for acute appendicitis in pediatric patients

Background: Appendicitis is a medical emergency that usually necessitates surgery and antibiotics in pediatric patients. There is a lack of consensus regarding optimal antibiotics for pediatric appendicitis, with varying recommendations in guidelines and literature. Recent studies have shown that narrow-spectrum and broad-spectrum antibiotics produce similar outcomes in the treatment of pediatric appendicitis. At our institution, cefoxitin has replaced piperacillin/tazobactam for the management of pediatric appendicitis. We compared patient outcomes, including readmission rates, among patients treated with cefoxitin or piperacillin/tazobactam for surgically managed appendicitis.

Methods: We retrospectively reviewed medical charts of surgically managed pediatric appendicitis patients between the ages of 3 to 18 years who received piperacillin/tazobactam or cefoxitin. Those who received piperacillin/tazobactam from 2014-2015 were compared to those who received cefoxitin from 2015-2016. Patients were excluded if they received antibiotics for other indications or if they were initiated prior to hospital admission. Data collection included age, gender, race, days of antibiotics, length of stay, days of fever and readmission within 30 days. The primary outcome was treatment failure defined as inpatient readmission for any complication within 30 days of discharge. Secondary outcomes were hospital length of stay and days of fever.

Results: After screening 564 patient charts, 315 were included in the study with 174 in the piperacillin/tazobactam and 141 in the cefoxitin arm. Similar rates of perforations were observed in both groups. In the piperacillin/tazobactam group, there were 4 patients readmitted within 30 days of discharge compared to 2 in the cefoxitin arm, which was not statistically significant. Longer hospital length of stay and days of antibiotics in the piperacillin/tazobactam arm compared to cefoxitin was found to be statistically significant.

Conclusion: Cefoxitin was found to be non-inferior to piperacillin/tazobactam for the treatment of surgically managed acute appendicitis in pediatric patients at our institution.