Antibiotics Over Surgery for Initial Treatment of Appendicitis in Children

A meta-analysis study published in JAMA Pediatrics investigated the effectiveness and safety of antibiotic treatment over surgical intervention in children with uncomplicated appendicitis.


The appendix is a blind-ended tube connected to the cecum, the initial part of the large intestine. Appendicitis is an inflammation of the appendix, which is acute and painful condition felt at the right side of the abdominal. Acute appendicitis is one of the most common reasons for visits to the emergency and a surgical appendectomy (first reported in 1889) is the standard treatment.  However, surgical intervention comes with a risk of post-surgical complications and may be avoided with antibiotic treatment in uncomplicated cases.

Several Randomized Clinical Trials (RCT) have proven that non-operative treatment may be an effective and safe alternative to surgical intervention in adult patients with uncomplicated appendicitis, with the success rates ranging from 63 to 85%.  There are anatomical and pathophysiological differences between adults and pediatric patients, and results from clinical studies on adult population cannot be applied to children. An article published in JAMA Pediatrics presents results of a meta-analysis (statistical analysis combining results of many studies) of data from multiple studies investigating the effectiveness and safety of antibiotic versus surgical intervention for pediatric patients with uncomplicated appendicitis.

To reduce bias, a search for articles was performed by two independent reviewers using a defined set of terms to identify clinical studies on appendicitis in pediatric groups. The data from 5 studies describing the treatment of a total of 404 patients (ages 5-18) with uncomplicated appendicitis was evaluated. Of the 404 patients, 168 received antibiotics and 236 underwent appendectomy. Patients with complicated appendicitis were not included in the study. For the antibiotic group, successful…

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