Probiotics and Antibiotic Associated Diarrhea in Pediatric Complicated Appendicitis
Probiotics and Antibiotic Associated Diarrhea in Pediatric Complicated Appendicitis
To determine the effectiveness of the use of probiotics in patients with a diagnosis of
 complicated appendicitis on antibiotic associated diarrhea (AAD). Probiotics are defined as
 live microbial organisms that when administered in sufficient amounts, can provide a
 protective benefit to the individual patient. The use of probiotics in a pediatric population
 exposed to antibiotics and gastrointestinal surgery such as an appendectomy may provide a
 protective effect and prevent antibiotic associated diarrhea (ADD)
Appendicitis is the most common urgent surgical procedure performed on children.
 Approximately one third of the population end up having complicated appendicitis with
 evidence of peritoneal contamination and infection or abscess requiring the use of IV
 antibiotics and prolonged hospital stay. Antibiotic Associated Diarrhea (AAD) is a common
 complication seen in both outpatient and inpatient settings in approximately a third of all
 patients treated with antibiotics (Mantegazza, et al., 2018). In particular, pediatric
 patients experience ADD 11-62% of the time and can up upwards to 80% in hospitalized toddlers
 (Mantegazza, et al., 2018). Current literature defines AAD as three or more liquid stools per
 day. The causes of AAD are often related to the use of multiple antibiotics, prolonged
 hospital stay and gastrointestinal surgery. Antibiotics often disturb the normal enteric
 microbiome in the gut and allow for an increased growth of pathogens (Hojsak, 2017). AAD can
 occur as late as six to eight weeks after antibiotic exposure. Lactobacillus rhanmosus
 GG(LGG®)(Culturelle) is an over the counter dietary supplement that can help to restore the
 balance in the gut by promoting colonization to support better digestion and immune
 health.This study does not intend to investigate route of administration, dose, patient
 population, or other factor that significantly increases the risk (or decreases the
 acceptability of the risk) associated with the use of the dietary supplement.At Children's
 Medical Center, the investigators see over 1000 cases of appendicitis a year with
 approximately 1/3 of those patients being complicated appendicitis. For those requiring
 immediate appendectomy, the typical course of treatment include surgery, admission to the
 hospital for 3 to 5 days, administration of IV antibiotics while in hospital, and discharge
 orders for oral antibiotics to complete their treatment. The investigators propose to perform
 a randomized controlled trial where one group of patients will receive probiotic therapy and
 another group of patients does not. The investigators hypothesize patients given probiotics
 after a diagnosis of complicated appendicitis with immediate appendectomy who receive
 antibiotic treatment during their inpatient stay will decrease the overall length of stay
 (LOS) by 25% vs the LOS in those patients who do not receive probiotics.
Inclusion Criteria:

 1. Patients with a post-operative diagnosis of complicated appendicitis who undergo an
 immediate appendectomy.

 2. Patients between the ages of 4 and 18 years of age.

 Exclusion Criteria:

 1. Patients diagnosed with an complicated appendicitis with deferred appendectomy or
 non-perforated appendicitis

 2. Patients that have a history of being immunosuppressed, on immunosuppression therapy,
 or long-term steroid therapy within the last month.

 3. Patients that have central line access.

 4. Patients under 4 years of age.

 5. Patients that are developmentally delayed and cannot ambulate at baseline.

 6. Patients with significant past medical history.

 7. Patients that are in Child Protective Services custody.

 8. Patients that are incarcerated.

 9. Patients that are pregnant.

 10. Patients that speak languages other than English and Spanish.

 11. Patients admitted to units other than the general surgery floor (C4).