Evaluation of white blood cell count at time of discharge is associated with limited oral antibiotic therapy in children with complicated appendicitis

• Published in: The American journal of surgery Vol. 217; no. 6; pp. 1099 - 1101
• Main Authors: Bonasso, Patrick C., Dassinger, Melvin S., Wyrick, Deidre L., Smith, Samuel D., Burford, Jeffrey M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2019; Elsevier Limited
• Subjects: Abdominal Abscess - blood; Abdominal Abscess - epidemiology; Abdominal Abscess - etiology; Abdominal Abscess - prevention & control; Administration, Oral; Adolescent; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antibiotics; Appendectomy; Appendicitis; Appendicitis - blood; Appendicitis - complications; Appendicitis - drug therapy; Appendicitis - surgery; Blood; Child; Child, Preschool; Children; Clinical medicine; Combined Modality Therapy; Discharge; Drug Administration Schedule; Female; Hospitals; Humans; Intravenous administration; Leukocyte Count; Leukocytes; Leukocytosis; Leukocytosis - blood; Leukocytosis - diagnosis; Leukocytosis - etiology; Male; Oral antibiotics; Patient Discharge; Patient Readmission - statistics & numerical data; Patients; Pediatrics; Perforated appendicitis; Postoperative Care - methods; Postoperative Complications - blood; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Retrospective Studies; Studies; Therapy; Treatment Outcome; White blood count at discharge; White blood count at discharge; Perforated appendicitis; Oral antibiotics
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2018.12.071

Variation exists for postoperative antibiotics in children with complicated appendicitis. We investigated the impact of white blood count (WBC) at discharge on oral antibiotic therapy, abscess rate, and readmission rate.
We conducted a two year review of children with complicated appendicitis. In the pre-protocol group, total antibiotic therapy was ten days (IV and oral) and home oral antibiotics at discharge. In the post-protocol group, children with leukocytosis were prescribed oral antibiotics to complete seven days of total antibiotic therapy and children without leukocytosis were not prescribed oral home antibiotics.
There was no difference between mean hospital days after operation (3.52 vs. 3.24, p = 0.5111), means days of inpatient intravenous antibiotics (3.13 vs. 2.58, p = 0.5438), post-operative abscess rates (20.7% vs. 19.6%, p = 0.9975), or readmission rate (13.4% vs. 12.4%, p = 1.000).
The post-protocol group had a shorter average total antibiotic duration (4.24 vs. 9.52 days, p < 0.001) and were more likely to be discharged without oral antibiotics (71.1% vs 8.5%, p < 0.001).
Limiting home antibiotics at discharge to children with leukocytosis significantly decreases home antibiotic use.
•White blood count at discharge determines oral antibiotic prescribing.•Decreased home oral antibiotic usage for perforated appendicitis.•No change in readmission or abscess rate.
This study reviews one year prior to and one year after a protocol change for the antibiotic regimen for perforated appendicitis. Once a pediatric patient met discharge criteria, a white blood count was used to determine further home oral antibiotic treatment. The addition of WBC evaluation decreased the use of home antibiotics without an increase in readmission rate.