For Appendicitis, Antibiotics May Be Enough

Uncomplicated acute appendicitis in children may be effectively treated with antibiotics

(RxWiki News) Surgery has long been the gold standard in appendicitis treatment. But a new discovery could change that.

A new study from Nationwide Children's Hospital found that antibiotics alone may be a safe and effective alternative to surgery for kids with uncomplicated acute appendicitis (UAA).

"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 it was worth it to try antibiotics to avoid surgery," said lead study author Peter C. Minneci, MD, a researcher at Nationwide Children's, in a press release. "These patients avoided the risks of surgery and anesthesia, and they quickly went back to their activities."

Appendicitis is an inflammation of the appendix, a small pouch that projects from the colon on the right side of the abdomen. The specific purpose of the appendix in the body is unclear.

Although anyone can develop it, appendicitis most often occurs in patients younger than 30. Standard treatment is the surgical removal of the appendix, called an appendectomy.

For this study, Dr. Minneci and team looked at 102 patients ages 7 to 17 who were diagnosed with UAA between 2012 and 2013. All had mild appendicitis, meaning they had stomach pain for no more than 48 hours and had undergone tests to rule out rupture, among other factors.

Families were given the option to treat their child's appendicitis with antibiotics alone or with surgery. Thirty-seven families chose antibiotic treatment. The rest opted for surgery.

The kids in the nonoperative group were admitted to the hospital immediately and given IV antibiotics for at least 24 hours, followed by oral antibiotics for 10 days.

Among those patients, 95 percent showed improvement within 24 hours and were discharged from the hospital. Two patients were readmitted within 30 days for surgery.

After one year, these researchers found that 3 out of 4 patients in the nonoperative group had not developed appendicitis again or undergone surgery.

Appendicitis is the most common reason for emergency abdominal surgery in children, sending more than 70,000 kids to the operating room each year in the US. Surgery is often necessary to keep patients safe, but this study found that, sometimes, antibiotics can also do the trick.

This study was online Dec. 16 in the journal JAMA Surgery.

The National Institutes of Health, the Research Institute at Nationwide Children’s Hospital and the National Center for Advancing Translational Sciences funded this research.

No conflicts of interest were disclosed.

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Review Date: 
December 15, 2015