Antibiotics may be an effective treatment for acute uncomplicated appendicitis (AUA) in children, according researchers at the University of Southampton in England.
Researchers, led by Nigel Hall, PhD, an associate professor of pediatric surgery at the University of Southampton, and a consultant pediatric and neonatal surgeon at Southampton Children’s Hospital, reviewed 10 studies published over the past 10 years reporting on 413 children who received antibiotics instead of appendectomies. Despite a 14% rate of recurrent appendicitis, none of the studies noted any safety concern of specific adverse events related to antibiotics (Ann Emerg Med 2016 Dec 11. [Epub ahead of print]).
Appendectomies are “invasive and costly, not to mention extremely daunting for the child concerned and their family. Our review shows that antibiotics could be an alternative treatment method for children,” Dr. Hall said. “This now needs to be explored more widely.”
Complementing this sentiment, David Talan, MD, a professor of medicine at the University of California, Los Angeles School of Medicine, said antibiotics “potentially spares the patient the extant risk of anesthesia, the surgery and its complications, and we have found in our recent paper, ‘Antibiotics-First Versus Surgery for Appendicitis,’ that most patients can even be successfully treated without hospital admission, another place a person could acquire resistant bacteria and C. diff [Clostridium difficile].”
While the development of antibiotic resistance in children is always a concern, antibiotic treatments for AUA are unlikely to pose “any substantial risk of altering local bacterial resistance for the community on the order of prescriptions for colds, bronchitis, ear infections, nonspecific febrile and viral illness, or that posed by antibiotics used in food animals,” said Dr. Talan, who is also chair of the Department of Emergency Medicine at UCLA Medical Center.
More research must be done on longer-term clinical outcomes and cost-effectiveness of antibiotics compared with appendectomies.
Dr. Hall and his colleagues are working on a yearlong feasibility trial, which randomly allots children with appendicitis to undergo either surgery or antibiotic treatment.
“In our initial trial, we will see how many patients and families are willing to join the study and will look at how well children in the study recover. This will give us an indication of how many children we may be able to recruit into a future larger trial and how the outcomes of nonoperative treatment compare with an operation,” Dr. Hall said.
In a similar vein, CODA (Comparing Outcomes of Drugs and Appendectomy) is an ongoing study comparing surgical and antibiotic treatments for appendicitis in adults. (Read a commentary on this topic by Michael Gotlieb, MD, and Benton Hunter, MD, in the March issue of the Annals of Emergency Medicine.)
“Recent studies have challenged the belief that surgery is the best option by showing that antibiotics can treat appendicitis safely and successfully without surgery in as many as three out of four patients,” said Giana Davidson, MD, MPH, an acute care surgeon in the Department of Surgery at the University of Washington Medical Center, in Seattle, and the director of the Clinical Coordinating Center for the CODA study. “Although studies show that both treatments for appendicitis are safe, it remains to be determined if antibiotics are as good as appendectomy for the outcomes that matter most to patients.”
Dr. Davidson and her colleagues are recruiting and following 1,552 patients at eight participating hospitals in Washington and California to track outcomes.
“Results of this study will support an evidence-based approach to appendicitis care and help nearly 300,000 Americans each year make an important health care decision about this common condition,” Dr. Davidson said.
New insights from these studies will shape how future cases of appendicitis are treated for people of all ages, the researchers said.
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