Taking antibiotics alone for kids with uncomplicated acute appendicitis is an effective and safe substitute to surgery, as revealed by a new study in the United States.
Surgical removal of the appendix has long been the standard for treatments because the procedure eliminates the risk of the infection coming back.
However, researchers at the Nationwide Children's Hospital observed that patients who took antibiotics the night before surgery actually felt fine the next day. The observation made them wonder if surgical procedures are really required.
In a study featured in the journal JAMA Surgery, doctors examined 102 patients with uncomplicated acute appendicitis aged 7 to 17 years old, and were diagnosed at NCH between October 2012 and March 2013. Their families were given the choice to try antibiotic treatment or go straight into surgery.
Only 37 of the families opted for the first treatment, while 65 chose surgery. Patients in the first treatment were given intravenous antibiotics for 24 hours and oral antibiotics for 10 days after discharge from NCH. Of these patients, 95 percent exhibited improvement within a day. A year after their treatment, 75 percent of the patients were not required to undergo surgery anymore and appendicitis did not relapse.
Dr. Peter Minneci, lead author of the study, said families who choose antibiotic treatments, and those who ended up with appendectomy because the antibiotics did not work for them, all expressed that it was worthwhile to try antibiotics to avoid surgery.
Most parents are concerned about the potential risks for their children who undergo surgery and are injected with anesthesia. Minneci meanwhile said the antibiotic alternative allows patients to prevent these risks.
"These patients avoided the risks of surgery and anesthesia, and they quickly went back to their activities," said Minneci.
Dr. Katherine Deans, Minneci's co-researcher, said the findings of the study reflect the efficacy of offering non-surgical management to patients and their families.
Still, Minneci and Deans said they do not stress that the one treatment is better than the other. Deans said the choice of treatment is a matter of aligning values and preferences with what is best for the patient.
NCH now offers the choice of antibiotic treatments to patients with simple cases of appendicitis. Minneci expects other hospitals to begin developing protocols to introduce the alternative, too.
"I think if a family walks in the ER now and they bring it up, the surgeon should discuss it with them because it's a reasonable option," added Minneci.
Photo : Michael Mortensen | Flickr
