Exploring oral antibiotics for antibiotic stewardship in nonoperative management of complicated appendicitis in pediatric patients.

Introduction: Culture data may help determine antibiotic administration options for nonoperative complicated appendicitis. Variability exists in treatment strategies, from solely using intravenous therapy, including outpatient parenteral antibiotic treatment (OPAT), to transitioning to oral (PO) antibiotics. We hypothesize that most patients have an oral antibiotic option based on culture results and that there is no increased rate of readmission due to treatment failure with oral antibiotics. Methods: This was a single-center retrospective cohort study reviewing antibiotic treatment of pediatric patients treated with nonoperative management for complicated appendicitis with abscesses percutaneously drained by Interventional Radiology (IR). We compared case-mix demographic variables, choice and route of antibiotic therapy, culture data, and clinical outcomes between those who exclusively received parenteral antibiotics therapy (PAT) and those who were switched to oral therapy (PO). Results: We identified 54 cases of nonoperative complicated appendicitis who underwent IR abscess drainage from 2014 to 2019. Forty-five [83%] patients completed therapy with PAT and 9 with PO; forty-six of 54 patients (85%) patients had an oral antibiotic(s) option based on sensitivities. Readmissions and complications included 6 (11%) patients. Three (50%) patients were readmitted due to antibiotic treatment failure with worsening of abscess formation, 2 due to PICC (peripherally inserted central catheters) issues, and 1 due to a drug reaction. Conclusions: Most patients with nonoperative complicated appendicitis can be transitioned to oral antibiotic options based on the culture susceptibility profiles.