Once Daily Metronidazole for Perforated Appendicitis
Once Daily Metronidazole for Perforated Appendicitis
The objective of this study is to determine whether administering once-daily doses of
 metronidazole, an intravenous (IV) antibiotic used to prevent infection in perforated
 appendicitis, is as effective in children as delivering it in the standard method of once
 every eight hours. Reducing the frequency of administration has the potential of decreasing
 personnel time and healthcare cost and increasing the lifespan of the IV line.

 To determine the effectiveness once-daily administration, a randomized controlled trial (RCT)
 will be conducted to compare outcomes between the two treatment schedules. We will recruit
 100 patients (50 per treatment) aged 5-18 being surgically treated for perforated
 appendicitis at the Children's Hospital of Eastern Ontario, who will be randomly assigned to
 one of the two treatment schedules. To compare the efficacy of the treatments, outcomes such
 as duration of hospital stay and theoretical cost will be measured and analyzed using
 statistical tests.
Inclusion Criteria:

 -  All children 5-18 years of age, presenting to CHEO with perforated appendicitis
 (confirmed either in the operating room or diagnosed preoperatively according to
 radiological criteria), and managed surgically will be assessed for eligibility to
 participate. These patients may participate if baseline lab values of serum AST
 (SGOT), AL T (SGPT), LDH, triglycerides and hexokinase glucose are normal, complete
 physical exam is normal, hGC test is negative for pregnancy (if the patient is a
 female of reproductive age) and none of the exclusion criteria are present.

 Exclusion Criteria:

 -  Any known co-existing gastrointestinal disease

 -  Uncertainty about the diagnosis

 -  Perforated appendicitis with diffuse abdominal fluid on imaging associated with a
 clinical picture of severe sepsis

 -  A known allergy to any of the antibiotics to be used in this trial

 -  An active neurological disorder

 -  Receiving medical treatment for a neurological disorder

 -  A history of blood dyscrasia, hypothyroidism or hypoadrenalism

 -  Hepatic disease

 -  Renal impairment

 -  Patients receiving any other oral or intravenous concomitant antimicrobial at
 enrollment

 -  Pregnancy

 -  Under five years of age

 -  Patients who have received metronidazole orally or intravenously in the last 14 days,
 prior to the current admission for appendicitis

 -  Patients already taking any of the following medications at admission (as these may
 interact with Metronidazole as stated in the product monograph): disulfiram, oral
 anticoagulant therapy (warfarin type), phenytoin or phenobarbital, vecuronium,
 lithium, busulfan

 -  The physician elects to treat the patient conservatively (non-surgically)