Treatment with antibiotics alone can be a safe and effective alternative to surgery for children with uncomplicated acute appendicitis, according to a new study.
The study was led by Dr. Peter Minneci and Dr. Katherine Deans, co-directors of the Center for Surgical Outcomes Research at The Research Institute, part of Nationwide Children's Hospital in Columbus, Ohio.
"Surgery has long been the 'gold standard' of care for treating appendicitis because by removing the appendix we eliminate the chance that the appendicitis will ever come back," Deans said in a hospital news release.
"However, early in our careers we noticed that patients with appendicitis who were placed on antibiotics overnight until their surgery the following morning felt better the next day," she added. "So, Pete and I asked ourselves: do they really need to have surgery?"
Minneci agreed. "Families who choose to treat their child's appendicitis with antibiotics, even those who ended up with an appendectomy because the antibiotics didn't work, have expressed that for them it was worth it to try antibiotics to avoid surgery," he said.
To find out just how effective an antibiotics-alone approach might be, the researchers tracked outcomes for 102 patients aged 7 to 17 who developed uncomplicated acute appendicitis. These cases involved "early/mild" appendicitis -- meaning, among other things, that the organ had not ruptured and the child's abdominal pain had not lasted beyond 48 hours.
Thirty-seven of the children in the study received antibiotics while the other 65 had surgery, the researchers said.
Those in the antibiotics group were admitted to hospital and received intravenous antibiotics for at least 24 hours, and then took antibiotics in pill form for 10 days after they left the hospital.
Nearly all (95 percent) of those patients showed improvement within 24 hours and did not require surgery, the researchers reported.
Two patients in the antibiotics group had to be readmitted to the hospital within 30 days to have their appendix removed. After one year, 75 percent of the patients who received antibiotics did not develop appendicitis again and had not undergone surgery.
Within 30 days of leaving the hospital, rates of appendicitis-related medical care were similar for both groups, the team added.
The findings "reflect the effectiveness of offering non-operative management to patients and their families in clinical practice," Deans said in the news release.
The fact that the child's parents help decide between antibiotics and surgery is key, she added.
"Most parents are concerned about having surgery, in general," Deans said. "They're also very concerned about anesthesia. Some parents are very concerned about appendicitis coming back. It's really a matter of aligning your preferences, your values, what you think is most important to you, with the treatment that is best for you and your family."
One expert stressed, however, that appendicitis presents in many different ways -- not all of which are amenable to an antibiotic-only approach.
"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," explained Dr. Terry Amaral, associate chief of pediatric orthopedic surgery at Cohen Children's Medical Center in New Hyde Park, N.Y.
"Antibiotics alone can be safe and effective for management of appendicitis," he said. However, Amaral contends 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."
Appendicitis is caused by a bacterial infection of the appendix. It remains the leading reason for emergency surgeries in children, sending more than 70,000 U.S. kids to hospital operating rooms each year, according to the study authors.
The study was published in the Dec. 16 online edition of JAMA Surgery.
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