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Published on: November 17, 2018
Initial antibiotic treatment for acute simple appendicitis in children is safe: Short-term results from a
Ramon R Gorter1, Johanna H van der Lee2, Huibert A Cense3
1Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, Amsterdam, The Netherlands; Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
Insights
This study shows that a randomized controlled trial (RCT) for initial antibiotic treatment of acute appendicitis in children is feasible and safe. The antibiotic approach demonstrated promising results for treating pediatric acute simple appendicitis.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Clinical Trials
Background:
- Antibiotic treatment for acute appendicitis is established as safe in adults.
- Limited data exists on the safety and efficacy of non-operative management for acute appendicitis in children.
Purpose of the Study:
- To assess the feasibility of a randomized controlled trial (RCT) for initial antibiotic treatment versus appendectomy in children.
- To evaluate the safety of antibiotic treatment for acute simple appendicitis in pediatric patients.
Main Methods:
- A multicenter, prospective cohort study included 7-17 year olds with radiologically confirmed simple appendicitis.
- Patients received intravenous antibiotics (amoxicillin/clavulanic acid and gentamicin) for 48-72 hours, followed by oral antibiotics if improved.
- Appendectomy was performed for clinical deterioration or lack of improvement after 72 hours; adverse events were closely monitored.
Main Results:
- 25 out of 44 eligible patients participated (57% inclusion rate).
- 23 patients were symptom-free at 8-week follow-up; 2 underwent delayed appendectomy.
- No major adverse events or recurrent appendicitis were observed; three patients had minor complications.
Conclusions:
- An RCT comparing initial antibiotic treatment with appendectomy for pediatric acute simple appendicitis is feasible.
- Initial antibiotic treatment appears to be a safe strategy for selected children with acute simple appendicitis.
Background:
Initial antibiotic treatment for acute appendicitis has been shown to be safe in adults; so far, not much is known about the safety and efficacy of this treatment in children. The aims of this study were to investigate the feasibility of a randomized controlled trial (RCT) evaluating initial antibiotic treatment for acute appendectomy in children with acute simple appendicitis and to evaluate the safety of this approach.
Methods:
In a multicenter, prospective cohort study patients aged 7-17 years with a radiologically confirmed simple appendicitis were eligible. Intravenous antibiotics (amoxicillin/clavulanic acid 250/25 mg/kg 4 times daily; maximum 6,000/600 mg/d and gentamicin 7 mg/kg once daily) were administered for 48-72 hours. Clinical reevaluation every 6 hours, daily blood samples, and ultrasound follow-up after 48 hours was performed. In case of improvement after 48 hours, oral antibiotics were given for a total of 7 days. At any time, in case of clinical deterioration or non-improvement after 72 hours, an appendectomy could be performed. Follow-up continued until 8 weeks after discharge. Adverse events were defined as major complications of antibiotic treatment, such as allergic reactions, perforated appendicitis, and recurrent appendicitis.
Results:
Of 44 eligible patients, 25 participated (inclusion rate, 57%; 95% CI, 42%-70%). Delayed appendectomy was performed in 2, and the other 23 were without symptoms at the 8 weeks follow-up. Minor complications occurred in three patients. None of the patients suffered from an adverse event or a recurrent appendicitis.
Conclusion:
Our study shows that an RCT comparing initial antibiotic treatment strategy with urgent appendectomy is feasible in children; the intervention seems to be safe.
