Antibiotics are a safe and effective treatment option for children with uncomplicated appendicitis, suggests a new study. The research, published online Dec. 16 in the journal JAMA Surgery, found that when families chose antibiotics alone instead of immediate surgery to treat their child’s appendicitis, three out of four children recovered without needing surgical intervention.
Appendicitis occurs when the appendix, a finger-shaped pouch off the large intestine, becomes inflamed, generally by infection, blockage, trauma or intestinal disorders such as Crohn’s disease. According to the study authors, appendicitis is the most common reason for emergency surgery in children, sending 70,000 youngsters to the operating room each year.
And surgery has long been the “gold standard” of care for treating appendicitis. However, study co-authors Pete C. Menneci, MD, and Katherine J. Deans, MD, co-directors of the Center for Surgical Outcomes Research and principal investigators for the Center for Innovation in Pediatrics Practice in The Research Institute at Nationwide Children’s Hospital, noticed that many patients who were placed on antibiotics overnight in preparation for surgery felt better the next day.
“So Pete and I asked ourselves do they really need surgery,” Deans said in a news release.
To answer their question, Menneci and Deans screened 629 patients between the ages 7 and 17 who came to Nationwide’s emergency room between October 2012 and March 2013 with appendicitis. Among this group, about 22 percent did not have severe or complicated appendicitis. That is, they had abdominal pain for no more than 48 hours, had a white blood cell count below 18,000, underwent an ultrasound or CT scan to rule out rupture, and had no evidence of an abscess.
Overall, 102 patients were enrolled in the study. Of those, 37 families opted to have their children treated with at least 24 hours of intravenous antibiotics to be followed by 10 days of oral antibiotics at home. The remaining 65 families chose surgical treatment for their children.
Among the antibiotics-only patients, 95 percent showed improvement within 24 hours and were discharged without requiring surgery. One year after discharge, three out of four of the kids whose families chose antibiotics only were still healthy and did not require additional treatment.
Findings also showed that there was no significant difference in the number of appendicitis cases that went on to become complicated during surgery or after treatment with antibiotics. In addition, compared to the children who underwent surgery, the kids who took antibiotics needed an average of 13 fewer days of rest and had medical bills that were on average $800 lower.
“We believe that the results of our study reflect the effectiveness of offering non-operative management to patients and their families in clinical practice,” Deans said in the news release. “The patient choice design allows the patient and family’s preference to be aligned with their choice of therapy,” she added.
For example, explained Deans, parents worried about a recurrence of appendicitis, may choose surgery. For families concerned about their child going under anesthesia, treatment with antibiotics may be there first choice.
One expert, however, cautioned that not all cases of appendicitis are candidates for antibiotics-only treatment. “Appendicitis, as with any disorder or disease process in medicine, can be very simple or very complex and can encompass a large spectrum of severity, which necessitates different modes of treatment,” Terry Amaral, MD, associate chief of pediatric orthopedic surgery at Cohen Children’s Medical Center in New Hyde, N.Y., told HealthDay.
“Antibiotics alone can be safe and effective for management of appendicitis,” he said. But he also noted that this is the case in only “a very small subset of patients with this disorder – which requires a careful evaluation of the patient to see if they fall into that subgroup.”