A role for conservative antibiotic treatment in early appendicitis in children

Area of Science:

• Pediatric Surgery
• Infectious Diseases
• Gastroenterology

Background:

• Acute appendicitis (AA) is common in children.
• Surgical appendectomy is the traditional treatment.
• Non-operative management is being explored for select cases.

Purpose of the Study:

• To assess the efficacy of antibiotic-only treatment for children with suspected acute appendicitis.
• To determine if non-operative management is a viable alternative to surgery in early AA.

Main Methods:

• Prospective evaluation of children with clinical, laboratory, and ultrasound findings suggestive of AA.
• Eligible patients with mild symptoms and no peritonitis received intravenous followed by oral antibiotics.
• Exclusion of patients with severe symptoms or peritonitis.

Main Results:

• 45 children with early AA were included (ages 4-15).
• 42 of 45 children (89%) improved with antibiotics alone and were discharged within 3-5 days.
• 5 children (11%) required surgery: 3 within 24 hours, 2 for recurrent appendicitis at 2 weeks and 2 months.
• No recurrent appendicitis observed during 6-14 month follow-up.

Conclusions:

• Antibiotic therapy alone is a successful treatment for a majority of children with early acute appendicitis.
• A conservative, antibiotic-first approach is supported for early AA, demonstrating an 89% success rate.
• Non-operative management does not appear to increase morbidity in cases where surgery is ultimately required.