Antibiotics vs Surgery for Uncomplicated Appendicitis

Treatment with antibiotics could be an effective alternative to urgent surgery in children with uncomplicated appendicitis, according to the results of a recent study.

Previous research has suggested that nonoperative management of uncomplicated appendicitis is safe and effective in adults, and a growing body of evidence suggests that the same could be true in children.

To examine this further, the researchers conducted a nonrandomized controlled study involving 1068 children aged 7 through 17 years treated at 10 children’s hospitals in the US. Among the participants, 370 were treated with antibiotics alone, while 698 underwent laparoscopic appendectomy.

Overall, complete follow-up was available for 806 patients (284 in the nonoperative group and 522 in the surgery group). Following inverse probability of treatment weighting, the researchers found a success rate of nonoperative management at 1 year of 67.1% (96% CI, 61.5%-72.31%; P = .86). Management with antibiotics alone was also associated with a significantly lower rate of patient disability at 1 years than was surgery (adjusted mean, 6.6 vs 10.9 days; mean difference, −4.3 days (99% CI, −6.17 to −2.43; P < .001).

“Among children with uncomplicated appendicitis, an initial nonoperative management strategy with antibiotics was successful for most children and, compared with urgent surgery, was associated with significantly fewer disability days at 1 year,” the researchers concluded.

“However,” they noted, “there was substantial loss to follow-up, the comparison with the prespecified threshold for an acceptable success rate of nonoperative management was not statistically significant, and the hypothesized difference in disability days was not met.”

—Michael Potts

Reference:

Minneci PC, Hade EM, Lawrence AE, et al. Association of nonoperative management using antibiotic therapy vs laparoscopic appendectomy with treatment success and disability days in children with uncomplicated appendicitis. Published online July 27, 2020. JAMA. doi:10.1001/jama.2020.10888