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Conservative antibiotic treatment for acute uncomplicated appendicitis is feasible

Zvi Steiner1,2, Genady Buklan3,4, Michael Gutermacher3,4

  • 1Department of Pediatric Surgery, Meir Medical Center, 44281, Kfar Saba, Israel. zvi.steiner@clalit.org.il.

Pediatric Surgery International
|January 19, 2018
PubMed

Insights

Conservative antibiotic treatment (CAT) is a feasible option for acute uncomplicated appendicitis (AUA) in children. This approach offers a safe alternative to surgery for selected cases, achieving an 86.8% success rate without immediate appendectomy.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Infectious Diseases

Background:

  • The optimal management for acute uncomplicated appendicitis (AUA) in children, comparing appendectomy to conservative antibiotic treatment (CAT), is an ongoing debate.
  • Concerns exist regarding the practicality and long-term efficacy of CAT for AUA in pediatric populations.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of a conservative antibiotic treatment (CAT) protocol for acute uncomplicated appendicitis (AUA) in children.
  • To analyze the safety profile and success rates of CAT in a pediatric cohort using strict inclusion and exclusion criteria.

Main Methods:

  • A non-randomized, prospective cohort study was conducted involving children admitted between 2014 and 2016 with suspected AUA.
  • Data collection included clinical presentation, laboratory results, imaging, and pathology.
  • Follow-up utilized clinic visits, telephone calls, and national registry analysis.

Main Results:

  • Out of 362 children treated with CAT, only 19 required appendectomy within 1-2 days.
  • The overall success rate for CAT was 86.8%, with 75 readmissions for recurrent appendicitis over a 22-month follow-up.
  • Of those readmitted, 30 were successfully retreated with antibiotics, while 45 underwent appendectomy. Histological examination of recurrent cases showed no perforations.

Conclusions:

  • Conservative antibiotic treatment (CAT) is a feasible and safe management strategy for selected pediatric patients with acute uncomplicated appendicitis (AUA).
  • A rigorous diagnostic approach with strict patient selection criteria is crucial for achieving high success rates with CAT.
  • CAT serves as a viable alternative to surgery, without compromising the option for future appendectomy if necessary.
Abstract

Keywords:
AppendectomyAppendicolithChildrenConservative managementUncomplicated appendicitis

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