Comparison of Metronidazole q12h to q8h in Combination With Other Antibiotics on the Clinical Outcome and Readmission Rate of Patients With Appendicitis and Diverticulitis
Bibliographic record
Abstract
Background. Pharmacokinetic, pharmacodynamic and limited published clinical data support the administration of metronidazole in a twice daily (q12h) regimen versus three times daily (q8h). As part of an Antimicrobial Stewardship initiative, we started promoting this change in practice in March 2015 during weekly rounds with the General Surgery team. The objectives of this study are to determine if metronidazole 500 mg q12h differs from q8h in patients with appendicitis or diverticulitis, regarding 30-day clinical outcomes and readmission rates. Methods. A retrospective chart review of patients admitted with appendicitis or diverticulitis prior to, and after March 2015 was conducted. Patients prescribed a metronidazole-based regimen were assessed for clinical outcomes and readmission rates at 30 days. Charts were excluded if patients were already taking metronidazole on admission, prescribed metronidazole q12h and q8h during the same admission, prescribed only one dose of metronidazole, admitted with a concomitant infection, or if they had a fistula or chronic appendicitis. Results. Of 200 patients with appendicitis, 45 were included, and of 120 patients with diverticulitis, 36 were included. The primary reason for exclusion was not receiving metronidazole, or receiving only one dose. 82% of patients with appendicitis were treated surgically, and 92% of patients with a diverticulitis were treated conservatively. No statistical difference between the two groups was found for resolution rate. The 30-day readmission rate also did not differ between groups: 1/20 patients with appendicitis treated with q12h and 1/25 treated with q8h (p = 1.00), 1/15 patients with diverticulitis treated with q12h and 0/21 treated with q8h (p = 0.417). Limitations of this study include the small sample size and its observational design. Conclusion. This retrospective chart review suggests that metronidazole q12h does not differ from metronidazole q8h with respect to 30-day clinical outcomes and readmission rates of patients with appendicitis or diverticulitis. A larger sample size and more indications are being assessed. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".