When children present with uncomplicated acute appendicitis, antibiotics offer a good option over surgery, according to the results of what the reporting investigators describe as the first prospective study on nonoperative management of acute appendicitis in pediatric patients in the United States.
As researchers Peter C. Minneci, MD, MHSc, and colleagues wrote in Journal of the American College of Surgeons, the study involved 77 youths who had received a diagnosis of uncomplicated acute appendicitis from a surgeon in the emergency department at Nationwide Children’s Hospital in Columbus, Ohio.
The patients, aged 7 to 17 years, had experienced abdominal pain for 48 hours or less; had a white blood cell count below 18,000; had an ultrasound or computed tomography (CT) scan to establish that their appendix was 1.1 cm thick or smaller and to rule out rupture; and showed no indication of abscess or fecalith.
Thirty families opted for antibiotics alone and 47 selected surgery. Children in the nonoperative group were admitted to the hospital, where they received intravenous (IV) antibiotics for at least 24 hours, followed by a 10-day course of oral antibiotics after discharge.
Among that group of patients, 93% showed improvement within 24 hours. When symptoms persisted, three patients eventually underwent an appendectomy. None suffered a ruptured appendix.
“Based on the current study, children with uncomplicated appendicitis are good candidates for nonoperative management,” observed Katherine J. Deans, MD, who co-led the study with Minneci.
More than 80,000 children undergo appendectomies each year. Although many do require surgery, a significant number would qualify for treatment with antibiotics alone, Minneci pointed out in an accompanying statement. To further evaluate this option, Deans and Minneci are enrolling 10 other pediatric hospitals in similar trials.