Treatment of simple appendicitis cases with antibiotics is a reasonable alternative to surgery, according to a new study published in JAMA Surgery, which found that three out of four children were successfully treated without being operated on.
Research co-authors, Dr. Katherine Deans and Dr. Peter Minneci, from a children’s hospital in Ohio, found that many patients with acute appendicitis who were placed on drugs overnight felt fine the next day. Their observations prompted a study on 102 patients between the ages of 7 and 17 who had uncomplicated cases of acute appendicitis. The parents of the patients were given a choice between surgery and antibiotics. Thirty-seven opted to try the antibiotic treatment.
Only two out of the 37 were readmitted within the next 30 days for appendicitis surgery. Seventy-five percent did not require surgery as long as one year later. However, the researchers caution that without surgery there is a risk of the condition returning.
The new treatment, which reduces cost, recovery time, and time lost from school and work, requires IV antibiotics for at least 24 hours in the hospital, then 10 days of oral antibiotics at home. The children that avoided surgery needed an average of 13 fewer days of rest.
Minneci also said that the two treatment options are similar in terms of safety, with no significant difference in complications.
About 11 percent of all pediatric emergency room visits are due to appendicitis, and 70,000 children per year undergo appendectomies in the U.S. Nearly 25 percent of those cases are children whose pain has not lasted longer than 48 hours and whose appendix has not burst, making many of them appropriate candidates for the antibiotic treatment.
The researchers caution that patients with appendicitis still need to see a surgeon to determine whether antibiotics treatment is appropriate. Dr. Russel Jennings, A Boston Children’s Hospital surgeon, said that “it’s important you don’t change the quality of care.”
Jennings, who was not involved in the new study, said the antibiotic treatment for adults with appendicitis is probably already available in large medical centers, and perhaps for some of the large centers that treat children.