ANTIBIOTICS FOR APPENDICECTOMY IN CHILDREN AND ADOLESCENTS DURING THE PERIOPERATIVE PERIOD: AN INTEGRATIVE REVIEW

ABSTRACT Objective: To analyze the preoperative use of antibiotics in children and adolescents requiring appendectomy. Data source: Integrative review was performed in the MEDLINE, Latin American and Caribbean Health Sciences (LILACS) and Cochrane databases and the PubMed portal, with no time limit. The keywords used were: appendicitis, child, adolescent and antibacterial with Boolean AND. The articles included were published in Portuguese, English or Spanish and whose participants were under 18 years of age. Review articles and guidelines were excluded. The studies were classified according to their level of evidence and 24 papers were selected. Data collection and analysis: Seven randomized clinical trial studies (level of evidence II), eight cohorts (level III), seven retrospective observational studies (level V) and two historical documentary analysis (level IV) were selected. The studies addressed antibiotics used in acute appendicitis in both uncomplicated and complicated cases. Antibiotics initiated in the preoperative period showed a decrease in the rates of surgical wound infections. First-line (empiric) regimens were tested for sensitivity to microorganisms in peritoneal material cultures, however the results were controversial. Broad-spectrum antibiotics have been suggested in some studies because they have good coverage, but in others they have not been recommended because of the risk of developing bacterial resistance. Shorter administration time and earlier change to the oral route reduced hospitalization time. Conclusions: There are several clinical protocols with different antibiotics. However, there is no standardization concerning the type of antibiotic drug, time of use, or route.

摘要：
研究目的：分析需接受阑尾切除术的儿童与青少年的术前抗生素使用情况。
数据来源：本研究在MEDLINE、拉丁美洲与加勒比卫生科学（Latin American and Caribbean Health Sciences, LILACS）数据库、Cochrane数据库及PubMed平台开展整合性文献回顾，未设置时间限制。检索关键词为：阑尾炎、儿童、青少年、抗菌药物，采用布尔逻辑“与”进行组配。纳入语种为葡萄牙语、英语或西班牙语，且研究对象为18岁以下人群的文献，排除综述类文章及指南类文献，最终共筛选出24篇相关论文。
数据收集与分析：共纳入7项随机临床试验（证据等级II）、8项队列研究（证据等级III）、7项回顾性观察研究（证据等级V）及2项历史文献分析研究（证据等级IV）。上述研究均针对急性阑尾炎（包括单纯性与复杂性病例）中的抗生素使用展开。术前启动抗生素治疗可降低手术切口感染率。一线（经验性）给药方案针对腹膜标本培养中的微生物敏感性进行了验证，但结果存在争议。部分研究推荐使用广谱抗生素，因其具备良好的抗菌覆盖范围；但另有研究因顾虑细菌耐药风险而不建议采用此类方案。缩短给药时长、尽早转为口服给药途径可有效缩短住院时间。
研究结论：目前已有多种涵盖不同抗生素的临床方案，但在抗生素药物种类、使用时长及给药途径方面尚未形成统一标准。