No surgery for uncomplicated acute appendicitis?

A course of antibiotics-without surgery- is a perfectly reasonable way to treat uncomplicated acute appendicitis in children, according to a small pilot study.

Contrary to decades of the belief that urgent surgery is the only way to go, researchers from Nationwide Children’s Hospital in Columbus, Ohio, assert that a combination of intravenous (IV) and oral antibiotics is not only effective, but results in less pain and a faster return to school.

In a prospective, nonrandomized trial, the investigators let 77 patients and their caregivers choose between surgical and nonsurgical management. The patients were aged between 7 and 17 years, had experienced pain for no more than 2 days, and had a white blood cell count below 18,000. An ultrasound or computed tomography scan ruled out rupture and verified that the appendix was 1.1 cm thick or smaller with no evidence of abscess or fecalith.

Thirty participants chose the antibiotics, while the remaining 47 chose appendectomy. Those who chose the antibiotics received the agents via IV for the first 24 hours, followed by the oral route for 10 days after discharge. Almost all (93%) of the patients in the antibiotic group improved within 24 hours. Only 3 failed to respond and required surgery; none experienced rupture.

Compared with the surgical group, the children who received antibiotics had 3 disability days versus 17 and returned to school in 3 days versus 5. Both the patients and their parents had higher quality of life scores, but the children in the antibiotic group had almost double the length of hospital stay at 38 hours versus 20 hours for the surgical group because physicians were monitoring whether the drugs were working.

According to Nationwide Children’s Hospital, appendicitis is the most common reason for emergency abdominal surgery in children, accounting for more than 80,000 surgeries each year. The researchers say about half of those surgeries could be avoided with antibiotic treatment alone.

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