The Open Public Health Journal

ISSN: 1874-9445 ― Volume 13, 2020

The Effectiveness of Postoperative Antibiotics following Appendectomy in Pediatric Patients: A Cost Minimization Analysis

Rano K. Sinuraya1, 2, *, Aida N. Aini1, Cherry Rahayu3, Nasrul Wathoni4, Rizky Abdulah1, 2
1 Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia
2 Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
3 Department of Pharmacy, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
4 Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia



Appendicitis has a high occurrence and is frequently indicated in pediatric abdominal surgery. However, up to 33% of affected children may not present with distinct symptoms, and young children may be a typical or show delayed presentation of symptoms. Appendectomy is one of the most common emergent surgeries to treat appendicitis. After an appendectomy, prophylaxis antibiotics are required to abate infections at the location of surgery and have been shown to reduce postoperative surgical complications significantly.


The purpose of this investigation was to determine the most cost-effective prophylactic antibiotic combination between ceftriaxone-metronidazole and cefotaxime-metronidazole following appendectomy.


A retrospective observational study was conducted using investigations with a similar design and pediatric medical records from 2011 until 2013 from a referral hospital in Bandung City. All direct medical costs related to pediatric appendectomy were collected and discounted. Independent Student’s t-test and chi-square analysis were used.


The average total cost of ceftriaxone-metronidazole was USD 393.83/patient and that of cefotaxime-metronidazole was USD 397.89/patient. There were no significant differences in average direct medical costs between treatments with ceftriaxone-metronidazole and cefotaxime-metronidazole (p=0.383). The analysis suggests that both antibiotic combinations have the same effectiveness and cost. For the combinations of ceftriaxone-metronidazole and cefotaxime-metronidazole, approximately USD 1.88 and USD 2.28 were required, respectively, to reduce one day of hospitalization after an appendectomy. Additionally, to increase one percent of cure rate, an amount of USD 19.70 and USD 24.89 was required for ceftriaxone-metronidazole and cefotaxime-metronidazole, respectively.


Both therapies investigated were effective as a postoperative antibiotic. However, the combination of ceftriaxone and metronidazole may be more cost-efficient.

Keywords: Appendectomy, Ceftriaxone, Cefotaxime, Cost minimization analysis, Metronidazole, Antibiotics.

Article Information

Identifiers and Pagination:

Year: 2020
Volume: 13
First Page: 80
Last Page: 86
Publisher Id: TOPHJ-13-80
DOI: 10.2174/1874944502013010080

Article History:

Received Date: 22/06/2019
Revision Received Date: 19/12/2019
Acceptance Date: 08/1/2020
Electronic publication date: 20/03/2020
Collection year: 2020

© 2020 Sinurayaet al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia; Tel: +62 22 84288888, Fax: +62 22 84288888;

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