Are antibiotics a safe and effective alternative to surgery for some kids with appendicitis? A recent study published in JAMA Surgery suggests when chosen by the family, nonoperative management is an effective treatment strategy for children with uncomplicated acute appendicitis. We asked Mayo Clinic Children’s Center pediatric surgeon Dr. Dean Potter to help us understand the research and its significance.
“The study design is patient choice cohort study, thus after discussing both therapeutic options with the patient and family, the choice was given to the family and patient,” says Potter. “This was not a randomized study.”
About the study
Potter says this latest prospective study investigates the use of antibiotics versus appendectomy for the treatment of acute, uncomplicated appendicitis. “This study found that for a specific subset of patients with appendicitis, antibiotic therapy alone was effective for the treatment of appendicitis. This study excluded a large number of patients including complicated (perforated) appendicitis, young patients (younger than 7 years), presence of appendicoliths, white blood cell count above 18,000 leukocytes, abdominal pain longer than 48 hours, and elevated CRP. Only about 1 out of 6 patients they evaluated met the criteria for the study. With that said, for this specific group of children, antibiotics allowed 94.6 percent to avoid appendectomy during the initial hospital stay, 89 percent for the first 30 days, and 75.7 percent for 21 months following admission.”
What it means to patients
It’s important to recognize researchers worked with a very select group of patients, and their findings should not be generalized to all patients with appendicitis, points out Potter. He adds, “Additionally, long-term follow up is lacking, we do not know how many will have recurrent appendicitis in the next five or 10 years. Several secondary outcomes were used to support the nonoperative management of appendicitis. Cost and disability days significantly favored antibiotics over surgery. However, these outcomes maybe affected by recurrent bouts of appendicitis over time.”
What parents and caregivers should know
“Parents should be aware that antibiotics alone maybe an option if your child is diagnosed with acute, uncomplicated appendicitis. However, the vast majority of children still require operative management of appendicitis currently. Discussion with a pediatric surgeon is the best way to understand the options that are available for your child.” Potter adds, “Further evaluation of this topic is required before antibiotic therapy becomes standard of care.”
Appendicitis is the most common acute surgical disease in children, with more than 70,000 children diagnosed in the United States each year. Currently, treatment is dependent on the whether the disease is complicated or uncomplicated. Urgent (within 12 hours of observation) laparoscopic appendectomy is the standard of care for uncomplicated appendicitis. Complicated appendicitis may be treated with urgent laparoscopic appendectomy or delayed appendectomy depending on the presence of intra-abdominal phlegmon or abscess. Read more on the symptoms of appendicitis and when to seek medical attention.
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