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Comparison of Antibiotic Therapy and Appendectomy for Acute Uncomplicated Appendicitis in Children: A Meta-analysis
Libin Huang1, Yuan Yin2, Lie Yang2
1Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China2Laboratory of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China.
Insights
Antibiotic therapy for pediatric appendicitis is effective and safe, but surgery is preferred for cases with appendicolith. This approach may be feasible for uncomplicated appendicitis, reducing complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Infectious Diseases
Background:
- Antibiotic therapy for acute uncomplicated appendicitis is effective in adults but controversial in children.
- Pediatric appendicitis management requires evaluating non-operative versus surgical approaches.
Purpose of the Study:
- To compare the safety and efficacy of antibiotic treatment versus appendectomy for acute uncomplicated appendicitis in pediatric patients.
- To determine the optimal primary therapy for pediatric appendicitis.
Main Methods:
- A meta-analysis of randomized clinical trials and prospective controlled trials comparing antibiotic therapy and appendectomy.
- Searched PubMed, MEDLINE, EMBASE, and Cochrane Library databases up to April 2016.
- Included studies focused on pediatric patients (aged 5-18 years) and assessed treatment success, complications, and readmissions.
Main Results:
- Nonoperative antibiotic treatment was successful in 90.5% of 404 pediatric patients with uncomplicated appendicitis.
- The risk for treatment failure increased significantly in patients with appendicolith (risk ratio 10.43).
- Antibiotic therapy did not increase the risk of complications compared to appendectomy.
Conclusions:
- Antibiotics may be a feasible and effective initial treatment for pediatric uncomplicated appendicitis.
- Appendectomy is preferably recommended for appendicitis cases involving appendicolith due to higher failure rates with antibiotics.
- Further research may refine antibiotic protocols for specific pediatric appendicitis cases.
Importance:
Antibiotic therapy for acute uncomplicated appendicitis is effective in adult patients, but its application in pediatric patients remains controversial.
Objective:
To compare the safety and efficacy of antibiotic treatment vs appendectomy as the primary therapy for acute uncomplicated appendicitis in pediatric patients.
Data Sources:
The PubMed, MEDLINE, EMBASE, and Cochrane Library databases and the Cochrane Controlled Trials Register for randomized clinical trials were searched through April 17, 2016. The search was limited to studies published in English. Search terms included appendicitis, antibiotics, appendectomy, randomized controlled trial, controlled clinical trial, randomized, placebo, drug therapy, randomly, and trial.
Study Selection:
Randomized clinical trials and prospective clinical controlled trials comparing antibiotic therapy with appendectomy for acute uncomplicated appendicitis in pediatric patients (aged 5-18 years) were included in the meta-analysis. The outcomes included at least 2 of the following terms: success rate of antibiotic treatment and appendectomy, complications, readmissions, length of stay, total cost, and disability days.
Data Extraction And Synthesis:
Data were independently extracted by 2 reviewers. The quality of the included studies was examined in accordance with the Cochrane guidelines and the Newcastle-Ottawa criteria. Data were pooled using a logistic fixed-effects model, and the subgroup pooled risk ratio with or without appendicolith was estimated.
Main Outcomes And Measures:
The primary outcome was the success rate of treatment. The hypothesis was formulated before data collection.
Results:
A total of 527 articles were screened. In 5 unique studies, 404 unique patients with uncomplicated appendicitis (aged 5-15 years) were enrolled. Nonoperative treatment was successful in 152 of 168 patients (90.5%), with a Mantel-Haenszel fixed-effects risk ratio of 8.92 (95% CI, 2.67-29.79; heterogeneity, P = .99; I2 = 0%). Subgroup analysis showed that the risk for treatment failure in patients with appendicolith increased, with a Mantel-Haenszel fixed-effects risk ratio of 10.43 (95% CI, 1.46-74.26; heterogeneity, P = .91; I2 = 0%).
Conclusions And Relevance:
This meta-analysis shows that antibiotics as the initial treatment for pediatric patients with uncomplicated appendicitis may be feasible and effective without increasing the risk for complications. However, the failure rate, mainly caused by the presence of appendicolith, is higher than for appendectomy. Surgery is preferably suggested for uncomplicated appendicitis with appendicolith.
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