Are antibiotics necessary in nonperforated appendicitis in children? A double blind randomized controlled trial.
BACKGROUND
The use of antibiotics in uncomplicated appendicitis in children, remains the area of controversy. The aim of the study was to assess the necessity of antibiotic administration in nonperforated appendicitis in children.


METHODS
The design of the study was a double blind randomized controlled trial, with a follow-up of 4 to 20 months.


METHODS
Surgical Department in a University Pediatric Hospital.


METHODS
One hundred and eighty seven out of 249 children subjected to emergency appendectomies met the inclusion criteria, with 35 eligible but not included in the study. The remaining 152 patients were randomized; 41 had complicated appendicitis, 3 other diagnosis, 108 were analyzed within 3 study groups: 1 (n = 31) no antibiotic, 2 (n = 41) one dose, 3 (n = 36) 5-day course. Open appendectomy was a surgical procedure and Ceftriaxone 1.0 g i.v. was administered. Investigated parameters were: body temperature, WBC, bowel sounds, wound healing, recovery and morbidity.


RESULTS
Valid outcome data were available for 90 of 108 randomized patients. Protocols of 18 children due to fever > 39 degrees C, upper airway infection or allergy were disclosed. In the remaining 90 children, there were no differences in WBC and oral feeding between groups 1 (n = 24), 2 (n = 35) and 3 (n = 31). Group 1 and 2 had a higher mean temperature on day 1 post-op, without any clinical significance. A higher mean temperature was noted on day 5 post-op in group 1, due to wound infection in one patient. There were no intraabdominal abscesses. The only other complications were 2 adhesion small bowel obstructions (in groups 1 and 2 each).


CONCLUSIONS
Routine use of antibiotics in nonperforated appendicitis in children is not necessary.
Górecki
W J
WJ
Department of Pediatric Surgery, Children's Hospital, Jagiellonian University, 265 Wielicka St., 30-663 Cracow, Poland. migoreck@cyf-kr.edu.pl
Grochowski
J A
JA
D001064:Appendicitis / Q000188:drug therapy* / Q000503:physiopathology; D002443:Ceftriaxone / Q000008:administration & dosage / Q000627:therapeutic use*; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D004334:Drug Administration Schedule; D006801:Humans; D010919:Placebos; D011446:Prospective Studies; D016896:Treatment Outcome
D002511:Cephalosporins; D010919:Placebos; D002443:Ceftriaxone