Antibiotics may replace surgery as appendicitis treatment

Antibiotics may be an effective treatment for acute non-complicated appendicitis in children, instead of surgery, a new study published today has found.
The condition, which causes the appendix - a small organ attached to the large intestine - to become inflamed due to a blockage or infection, affects mainly children and teenagers.
Appendicitis is currently treated through an operation to remove the appendix, known as an appendicectomy, and it is the most common cause of emergency surgery in children.
The research led by Nigel Hall, Associate Professor at the University of Southampton in the UK, assessed existing literature published over the past 10 years that included 10 studies reporting on 413 children who received non-operative treatment rather than an appendectomy.

It shows that no study reported any safety concern or specific adverse events related to non-surgical treatment, although the rate of recurrent appendicitis was 14 per cent.
"Acute appendicitis is one of the most common general surgical emergencies worldwide and surgery has long been the gold standard of treatment," Hall said.

"But it is invasive and costly, not to mention extremely daunting for the child concerned and their family. Our review shows that antibiotics could be an alternative treatment method for children.
"When we compared the adult literature to the data in our review it suggested that antibiotic treatment of acute appendicitis is at least as effective in children as in adults. This now needs to be explored more widely," said Hall.

The research found that longer term clinical outcomes and cost effectiveness of antibiotics compared to appendicectomy require further evaluation, preferably as large randomised trials to reliably inform decision making.
To further this research Hall and his team, along with colleagues are currently carrying out a year-long feasibility trial which will see children with appendicitis randomly allocated to have either surgery or antibiotic treatment.
"In our initial trial, we will see how many patients and families are willing to join the study and will look at how well children in the study recover," Hall said.
"This will give us an indication of how many children we may be able to recruit into a future larger trial and how the outcomes of non-operative treatment compare with an operation," Hall added.

The research is published in the journal Pediatrics.