Nonoperative Treatment With Antibiotics Versus Surgery for Acute Nonperforated Appendicitis in Children

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Abstract

The aim of this study was to evaluate the feasibility and safety of nonoperative treatment of acute nonperforated appendicitis with antibiotics in children.

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A review of conservative treatment of acute appendicitis.

S Eaton, T Wester, Julie Hall … (2012)

Appendicitis is a common condition in the pediatric population and appendectomy has been the traditional treatment. Both the urgency of the operation and the need for the appendectomy have recently been challenged. In children, this controversy focuses on operative management of perforated appendicitis and appendix abscesses. In adults, the debate has extended to management of nonperforated appendicitis. This review describes the evidence behind these challenges and updates a per-protocol meta-analysis of randomized controlled trials in adults. In the per-protocol meta-analysis, there was no difference between operative versus nonoperative management in failure of treatment. The complication rate was significantly lower in patients treated nonoperatively. However, in the nonoperative group, 10% of patients needed immediate surgery and 17% developed a recurrence during the 1-year follow-up. Overall, 73% of adults with suspected acute appendicitis may not need operative treatment. There are no data in the literature to support nonoperative treatment of acute appendicitis in children. Copyright © 2012 by Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Current management of complicated appendicitis in children.

George Holcomb, Shawn St. Peter (2012)

The optimal management for children with complicated appendicitis remains unclear. However, our group has been interested in this disease, and has initiated several prospective randomized trials looking at various aspects of the care of these patients. In this article, we will discuss our definition of perforated appendicitis and how it was derived. We will also discuss a prospective randomized trial looking at the optimal antibiotic regimen and its relative place in the literature as well the data we have generated on the length of antibiotic therapy. We will also review the available data on the timing and necessity of appendectomy for perforated appendicitis. Finally, we will discuss the management of the difficult subset of patients who present with a well-defined abscess.