In the Journals

Antibiotics a safe alternative to appendectomy for appendicitis

The use of antibiotics was determined to be a safe and effective treatment for acute noncomplicated appendicitis in children, rather than appendectomy, according to research published in Pediatrics.

However, more research is needed to determine long-term clinical outcomes and the effectiveness of nonoperative treatment compared with appendectomy.

“The mainstay of treatment of acute appendicitis has been surgical ever since Fitz’s report over 130 years ago,” Roxani Georgiou, MRCS, from the department of pediatric surgery and urology at Southampton Children’s Hospital, and colleagues wrote. “However, in recent years, the dogma that surgery is required has been challenged, and there is growing literature to suggest that antibiotics without surgery may be an effective treatment of acute appendicitis in adults and more recently in children. This nonoperative treatment of acute appendicitis in children remains controversial and unproven at present due to a lack of randomized controlled trials (RCTs).”

To determine the safety and efficacy of nonoperative treatment, the researchers examined recent literature regarding comparing nonoperative treatment with appendectomy.

Three different electronic databases were used by researchers to compile information and chose all articles that included nonoperative treatment for acute uncomplicated appendicitis in pediatric patients. Once gathered, two reviewers independently verified study inclusion and collected data.  

Ten articles including 413 children who received nonoperative treatment were used in the analysis of data. Six of the articles and one RCT were used to compare nonoperative treatment with appendectomy. Four of the articles included nonoperative treatment with no comparison group. The two treatments were found to be equally effective in 97% of children, and the initial length of hospital stay was longer for those who received nonoperative treatment. Follow-up for participants ranged from 8 weeks to 4 years, and nonoperative treatment continued to be effective for 79% of the children who received it. Recurrent symptoms were demonstrated in 14% of participants. Although serious negative effects related to nonoperative treatment were reported, complications and total length of stay during follow-up were comparable for nonoperative treatment and appendectomy.

“Although it is tempting to draw conclusions regarding comparative efficacy from our comparative analysis of nonoperative treatment and appendectomy, we consider that to do so would be misleading because of the nature of the underlying studies,” researchers wrote. “We believe the best use of these data is to act as justification for the future investigation of nonoperative treatment and to guide sample size calculations in such studies where appropriate.” Katherine Bortz

Disclosure: The researchers report no relevant financial disclosures.

The use of antibiotics was determined to be a safe and effective treatment for acute noncomplicated appendicitis in children, rather than appendectomy, according to research published in Pediatrics.

However, more research is needed to determine long-term clinical outcomes and the effectiveness of nonoperative treatment compared with appendectomy.

“The mainstay of treatment of acute appendicitis has been surgical ever since Fitz’s report over 130 years ago,” Roxani Georgiou, MRCS, from the department of pediatric surgery and urology at Southampton Children’s Hospital, and colleagues wrote. “However, in recent years, the dogma that surgery is required has been challenged, and there is growing literature to suggest that antibiotics without surgery may be an effective treatment of acute appendicitis in adults and more recently in children. This nonoperative treatment of acute appendicitis in children remains controversial and unproven at present due to a lack of randomized controlled trials (RCTs).”

To determine the safety and efficacy of nonoperative treatment, the researchers examined recent literature regarding comparing nonoperative treatment with appendectomy.

Three different electronic databases were used by researchers to compile information and chose all articles that included nonoperative treatment for acute uncomplicated appendicitis in pediatric patients. Once gathered, two reviewers independently verified study inclusion and collected data.  

Ten articles including 413 children who received nonoperative treatment were used in the analysis of data. Six of the articles and one RCT were used to compare nonoperative treatment with appendectomy. Four of the articles included nonoperative treatment with no comparison group. The two treatments were found to be equally effective in 97% of children, and the initial length of hospital stay was longer for those who received nonoperative treatment. Follow-up for participants ranged from 8 weeks to 4 years, and nonoperative treatment continued to be effective for 79% of the children who received it. Recurrent symptoms were demonstrated in 14% of participants. Although serious negative effects related to nonoperative treatment were reported, complications and total length of stay during follow-up were comparable for nonoperative treatment and appendectomy.

“Although it is tempting to draw conclusions regarding comparative efficacy from our comparative analysis of nonoperative treatment and appendectomy, we consider that to do so would be misleading because of the nature of the underlying studies,” researchers wrote. “We believe the best use of these data is to act as justification for the future investigation of nonoperative treatment and to guide sample size calculations in such studies where appropriate.” Katherine Bortz

Disclosure: The researchers report no relevant financial disclosures.