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Are antibiotics necessary in nonperforated appendicitis in children? A double blind randomized controlled trial
1Department of Pediatric Surgery, Children's Hospital, Jagiellonian University, 265 Wielicka St., 30-663 Cracow, Poland. migoreck@cyf-kr.edu.pl
Insights
Routine antibiotic use is not necessary for children with uncomplicated appendicitis. A study found no significant differences in outcomes or complications between children receiving no antibiotics, a single dose, or a 5-day course post-surgery.
Area of Science:
- Pediatric Surgery
- Clinical Trials
- Infectious Disease Management
Background:
- The role of antibiotics in pediatric uncomplicated appendicitis is debated.
- Assessing the necessity of antibiotic administration is crucial for optimizing treatment protocols.
Purpose of the Study:
- To evaluate the necessity of antibiotic administration in children with nonperforated appendicitis.
- To compare outcomes in children undergoing appendectomy with varying antibiotic regimens.
Main Methods:
- A double-blind randomized controlled trial was conducted with a follow-up of 4 to 20 months.
- 108 pediatric patients with nonperforated appendicitis were randomized into three groups: no antibiotic, single-dose antibiotic, or 5-day antibiotic course.
- Outcomes including temperature, white blood cell count, wound healing, and morbidity were monitored post open appendectomy.
Main Results:
- Data from 90 patients were analyzed; no significant differences in white blood cell count or oral feeding were observed between the groups.
- Slightly higher mean temperatures were noted on postoperative days 1 and 5 in the no-antibiotic and single-dose groups, respectively, without clinical significance.
- No intra-abdominal abscesses occurred; two cases of adhesion small bowel obstruction were reported in the antibiotic groups.
Conclusions:
- Routine antibiotic use is not essential for children with nonperforated appendicitis.
- Antibiotic administration may not be necessary in all cases of uncomplicated appendicitis following appendectomy.
Background:
The use of antibiotics in uncomplicated appendicitis in children, remains the area of controversy. The aim of the study was to assess the necessity of antibiotic administration in nonperforated appendicitis in children.
Material And Methods:
The design of the study was a double blind randomized controlled trial, with a follow-up of 4 to 20 months.
Setting:
Surgical Department in a University Pediatric Hospital.
Patients:
One hundred and eighty seven out of 249 children subjected to emergency appendectomies met the inclusion criteria, with 35 eligible but not included in the study. The remaining 152 patients were randomized; 41 had complicated appendicitis, 3 other diagnosis, 108 were analyzed within 3 study groups: 1 (n = 31) no antibiotic, 2 (n = 41) one dose, 3 (n = 36) 5-day course. Open appendectomy was a surgical procedure and Ceftriaxone 1.0 g i.v. was administered. Investigated parameters were: body temperature, WBC, bowel sounds, wound healing, recovery and morbidity.
Results:
Valid outcome data were available for 90 of 108 randomized patients. Protocols of 18 children due to fever > 39 degrees C, upper airway infection or allergy were disclosed. In the remaining 90 children, there were no differences in WBC and oral feeding between groups 1 (n = 24), 2 (n = 35) and 3 (n = 31). Group 1 and 2 had a higher mean temperature on day 1 post-op, without any clinical significance. A higher mean temperature was noted on day 5 post-op in group 1, due to wound infection in one patient. There were no intraabdominal abscesses. The only other complications were 2 adhesion small bowel obstructions (in groups 1 and 2 each).
Conclusion:
Routine use of antibiotics in nonperforated appendicitis in children is not necessary.