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Antibiotics may be as effective as appendectomy

When children get appendicitis they usually have an emergency operation to remove their appendix. But new research shows that antibiotics may sometimes be just as effective as surgery in treating appendicitis.

BMJ Group News

What do we know already?

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The appendix is a finger-shaped pouch attached to the lower part of the colon (large intestine). When the appendix becomes inflamed this is called appendicitis. Appendicitis usually starts quite suddenly and can be very painful.

Doctors usually suggest emergency surgery to remove the appendix before it bursts. A burst appendix can be life-threatening. The operation is called an appendectomy or appendicectomy.

Recent research has shown that surgery isn’t always necessary. If the appendicitis is uncomplicated (there aren’t other problems, such as a hole in the appendix), antibiotics can effectively treat the condition.

About 20 in 100 cases of appendicitis are uncomplicated. This is usually confirmed with an ultrasound or CT scan of the abdomen.

So far, most of the research on antibiotic treatment has focused on adults. There has been one study that just looked at children, but it wasn’t big enough (only 16 children) to be certain that antibiotics are a safe alternative to surgery.

How was the new study done?

The new study was much larger than the first, with 77 children. The research took place at a children’s hospital in America. Families of children with appendicitis were asked if they wanted their child to have surgery (appendectomy) or antibiotics. Thirty families chose antibiotics for their child and 47 chose surgery.

The children who were given antibiotics stayed in the hospital for at least 24 hours. They were given the antibiotics through a drip (also called an IV or intravenous infusion) as well as medicine to ease their pain (analgesics). After the children left the hospital, they had to take antibiotic tablets. The total length of time children in the antibiotic-only group were on antibiotics was 10 days.

Children who had surgery also had to have antibiotics through a drip. This is standard for an appendectomy.

The researchers were mainly interested in the children who were only given antibiotics. They wanted to know how many of them managed to avoid having surgery for the first 30 days after their symptoms began.

What does the new study say?

Three of the 30 children who only had antibiotics had to have surgery to remove their appendix. The rest got better without surgery. None of the children had their appendix burst.

Children who had antibiotics took three days, on average, to recover. But children who had surgery took, on average, 17 days to recover.

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