Letter to the Editor Regarding: Pediatric Complicated Appendicitis: Results of a Standardized Antibiotic Protocol in a Tertiary Center

jpedsurg.org

We have read with great interest the paper, “Pediatric Complicated Appendicitis: Results of a Standardized Antibiotic Protocol in a Tertiary Center”by Estelle Studer et al.[1]. By comparing the first-line regimen of Ceftriaxone/Metronidazole (CM) with the alternative regimen of switching to Piperacillin/Tazobactam (PT) after CM treatment failure, they found that patients with preoperative CRP >150 mg/L and intraoperative intra-abdominal abscess might benefit from shorter hospital stays if PT was chosen as the first-line therapy.

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Article · Jan 2026 · 1 min read

In brief

This letter discusses antibiotic protocol optimization for pediatric complicated appendicitis, comparing first-line ceftriaxone/metronidazole versus piperacillin/tazobactam. Evidence suggests patients with elevated CRP (>150 mg/L) and intra-abdominal abscess may achieve shorter hospital stays with piperacillin/tazobactam as initial therapy.

Piperacillin/Tazobactam may reduce hospital stay vs Ceftriaxone/Metronidazole in complicated appendicitis with CRP >150 mg/L
Presence of intra-abdominal abscess at surgery predicts benefit from escalated first-line antibiotic therapy
Preoperative CRP >150 mg/L identifies patients who may benefit from Piperacillin/Tazobactam as initial treatment

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