antibiotics a safe and effective alternative to surgery for
some kids with appendicitis? A recent study published in JAMA
Surgery suggests when chosen by the family, nonoperative
management is an effective treatment strategy for children
with uncomplicated acute appendicitis. We asked Mayo Clinic
Childrenís Center pediatric surgeon Dr. Dean Potter to help
us understand the research and its significance.
study design is patient choice cohort study, thus after
discussing both therapeutic options with the patient and
family, the choice was given to the family and patient,"
says Potter. "This was not a randomized study."
says this latest prospective study investigates the use of
antibiotics versus appendectomy for the treatment of acute,
uncomplicated appendicitis. "This study found that for a
specific subset of patients with appendicitis, antibiotic
therapy alone was effective for the treatment of appendicitis.
This study excluded a large number of patients including
complicated (perforated) appendicitis, young patients (under 7
years of age), presence of appendicoliths, white blood cell
count above 18,000 leukocytes, abdominal pain longer than 48
hours, and elevated CRP. Only about 1 out of 6 patients they
evaluated met the criteria for the study. With that said, for
this specific group of children, antibiotics allowed 94.6
percent to avoid appendectomy during the initial hospital
stay, 89 percent for the first 30 days, and 75.7 percent for
21 months following admission."
MEANS TO PATIENTS
important to recognize researchers worked with a very select
group of patients, and their findings should not be
generalized to all patients with appendicitis, points out
Potter. He adds, "Additionally, long-term follow up is
lacking, we do not know how many will have recurrent
appendicitis in the next five or 10 years. Several secondary
outcomes were used to support the nonoperative management of
appendicitis. Cost and disability days significantly favored
antibiotics over surgery. However, these outcomes maybe
affected by recurrent bouts of appendicitis over time."
PARENTS AND CAREGIVERS SHOULD KNOW
should be aware that antibiotics alone maybe an option if your
child is diagnosed with acute, uncomplicated appendicitis.
However, the vast majority of children still require operative
management of appendicitis currently. Discussion with a
pediatric surgeon is the best way to understand the options
that are available for your child." Potter adds,
"Further evaluation of this topic is required before
antibiotic therapy becomes standard of care."
is the most common acute surgical disease in children, with
more than 70,000 children diagnosed in the United States each
year. Currently, treatment is dependent on the whether the
disease is complicated or uncomplicated. Urgent (within 12
hours of observation) laparoscopic appendectomy is the
standard of care for uncomplicated appendicitis. Complicated
appendicitis may be treated with urgent laparoscopic
appendectomy or delayed appendectomy depending on the presence
of intra-abdominal phlegmon or abscess. Read more on the
symptoms of appendicitis and when to seek medical attention.