Hamilton Health Sciences to lead national trial comparing antibiotics for ruptured appendix in children
The four-year study will compare two antibiotic treatments for 180 children at five hospitals across Canada.
HAMILTON — Hamilton Health Sciences will lead a four-year Canadian study comparing two antibiotic treatments for children whose appendix has ruptured.
The study, involving 180 patients at five children’s hospitals, will determine whether the stronger antibiotic piperacillin/tazobactam improves outcomes or whether the more commonly used ceftriaxone-metronidazole combination works just as well.
"Our goal is to find the best and safest treatment for kids with a perforated appendix," said Dr. Michael Livingston, a pediatric surgeon and health researcher at McMaster Children’s Hospital who is leading the study.
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"If the stronger antibiotic treatment leads to better outcomes, we’ll want to use it. But if it doesn’t provide any added benefit, we shouldn’t use stronger treatments unnecessarily."
The research, called ALPACA-MC, received more than $560,000 in direct funding from the Canadian Institutes of Health Research.
It marks the first time HHS has received CIHR funding directly rather than through a university partner.
"This new, direct funding pathway is a milestone that further positions HHS as a leading Canadian research hospital," said Dr. Marc Jeschke, vice president of research and innovation at HHS.
The study is expected to launch in 2027 and will include patients from children’s hospitals in Toronto, London, Calgary and Montreal, in addition to Hamilton.
It builds on a 10-month pilot study at McMaster Children’s Hospital led by Livingston and his team.
The CIHR-funded study will be a randomized, blinded trial, considered the gold standard in clinical research.
One group of patients will be randomly assigned to be treated with piperacillin/tazobactam, while the other group will receive a combination of ceftriaxone and metronidazole antibiotics.
The study is blinded, meaning only the pharmacist prescribing the antibiotic treatments knows which option each child receives.
Until now, there has never been a randomized, blinded study to compare the two treatment regimens and determine which is more effective.
Each year, almost 300 children and teens undergo emergency surgery for acute appendicitis at McMaster Children’s Hospital.
"Acute appendicitis is the most common reason for emergency surgery in children," said Livingston.
About one in three of these patients has a ruptured appendix, a serious complication that requires a hospital stay of several days to weeks for intravenous antibiotics.
After completing CIHR’s eligibility process, HHS was approved to apply directly for funding in December 2025.
When the CIHR project grant selection process opened for spring 2026, HHS submitted six projects for consideration, and Livingston’s was chosen to receive a $562,275 grant.
Canada-wide, the spring project grant selection process was highly competitive, with a total of 3,344 applications, and 439, or about 13 per cent, awarded funding.
"It’s a more streamlined process for our researchers," said Dr. Matthew Rätsep, HHS’ research grants specialist.
Rätsep said he has received 19 applications from HHS researchers for the fall 2026 competition, more than triple the number from spring.
"We expect even more applications from HHS researchers next year, when CIHR opens its 2027 spring project grant funding competition," added Rätsep.
For the ALPACA pilot, patients and their parents were invited to learn more about the study if there was enough time between their arrival, assessment and surgery.
Livingston said about 80 per cent agreed to join the pilot study.
Children in the pilot received a fluffy, made-in-Canada plush alpaca toy as a thank you from the team.
Isabelle Moreau is the editor of Novello Desserts and writes about family life and everyday living in Canada. The editor signs off on corrections and editorial standards.