Antibiotics could be a safe, effective alternative to surgery for children with appendicitis

The use of antibiotics alone has effectively helped children with uncomplicated acute appendicitis avoid surgery by improving their health. A new study shows that antiobiotics prevented the condition to relapse in three out of four young patients and promoted faster recovery, suggesting the treatment could be an effective alternative to surgery to help children.

Surgery has long been referred to as the “gold standard” of care in treating appendicitis, as removing the appendix can eliminate the chances of the condition to recur. However, researchers have discovered a non-operative approach that could offer less recovery time and lower health costs, with no difference in the rate of complications in one year when compared with surgery.

"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," said lead researcher Peter Minneci from Nationwide Children's Hospital. "These patients avoided the risks of surgery and anaesthesia, and they quickly went back to their activities."

The study, published in JAMA Surgery, involved 102 patients aged 7 to 17 who were diagnosed with uncomplicated acute appendicitis. The young participants had early or mild appendicitis, meaning they experienced abdominal pain for no more than 48 hours.

Antibiotics were used by 37 families to treat their children, while 65 chose surgery. The patients in the non-operative group who were admitted in the hospital received IV antibiotics for about 24 hours and oral antibiotics after discharge for a total of 10 days.

Results show that 95 percent of the patients who received antibiotics alone had improved health within 24 hours and were discharged without having surgery. Both groups had similar rates of appendicitis-related medical care within 30 days, but two patients in the non-operative group were readmitted within 30 days for an appendectomy.

A year after discharge, appendicitis did not recur in three out of four patients treated with antibiotics. "We believe that the results of our study reflect the effectiveness of offering non-operative management to patients and their families in clinical practice,” said researcher Dr Katherine Deans.

However, the researchers noted that perceptions of both patient-families and surgeons can impact the study results. Minneci and Deans said further studies are needed to see if their findings could be applied in other health systems. The researchers will also follow up on all the children in the study to further see the effect of non-operative management.

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