Could Antibiotics Replace Surgery for Mild Appendicitis?
Madison, Wisconsin - Children suffering from mild appendicitis may not need surgery to treat it.
The University of Wisconsin School of Medicine and Public Health and UW Health’s American Family Children’s Hospital have joined a multi-institutional clinical trial that offers a non-surgical treatment for children with uncomplicated appendicitis.
The pilot study, performed at Nationwide Children’s Hospital at Ohio State University, found that the use of antibiotics for uncomplicated appendicitis was an effective form of treatment. Uncomplicated appendicitis was defined as abdominal pain of 48 hours or less, a white blood cell count of 18,000 or less, and no evidence of an appendicolith, perforation, or abscess as determined by ultrasound or CT scan.
Patients who chose the non-operative treatment were observed in hospital for at least 24 hours and treated with intravenous antibiotics followed by 10 days of antibiotics by mouth. Investigators at American Family Children’s Hospital and 10 other children’s hospitals in the Midwest Pediatric Surgery Consortium have joined the clinical trial to see if the results can be replicated.
This is the first study of the use of antibiotics as an alternative to surgery for children with appendicitis.
“The public perception and even the perception of emergency medicine and primary care physicians is that you whisk patients to surgery for all appendicitis cases,” said Dr. Chuck Leys, associate professor of surgery and pediatric surgeon at American Family Children’s Hospital. “The pilot study suggests that there may be an effective non-surgical alternative for early, uncomplicated appendicitis.”
In the original pilot study, 65 patients chose appendectomy and 37 decided on antibiotic treatment. The success rate of non-operative management was 89 percent at 30 days and 76 percent at one year. While some patients who chose antibiotics ultimately required surgery, they did not have a higher rate of complicated or ruptured appendicitis compared to patients who had immediate appendectomy.
In addition, after one year, children treated with antibiotics instead of surgery had:
- Fewer disability days (eight days versus 21 days)
- Lower appendicitis-related health care costs (a median of $4,200 compared to $5,000)
- No difference in health-related quality of life
The current study is enrolling 800 participants, ages eight to 17 years old, at the 11 centers that are part of the Midwest Pediatric Surgery Consortium. The children will be followed for a year to determine how many patients are not successfully treated with antibiotics alone and ultimately need surgery.
“If the study goes well, I could envision antibiotics as a first-line therapy for mild appendicitis in the future,” said Dr. Leys.
Date Published: 04/18/2016