title: Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial.
abstract: OBJECTIVE
  The aim of this study was to evaluate the feasibility and safety of nonoperative treatment of acute nonperforated appendicitis with antibiotics in children.
  
  
  METHODS
  A pilot randomized controlled trial was performed comparing nonoperative treatment with antibiotics versus surgery for acute appendicitis in children. Patients with imaging-confirmed acute nonperforated appendicitis who would normally have had emergency appendectomy were randomized either to treatment with antibiotics or to surgery. Follow-up was for 1 year.
  
  
  RESULTS
  Fifty patients were enrolled; 26 were randomized to surgery and 24 to nonoperative treatment with antibiotics. All children in the surgery group had histopathologically confirmed acute appendicitis, and there were no significant complications in this group. Two of 24 patients in the nonoperative treatment group had appendectomy within the time of primary antibiotic treatment and 1 patient after 9 months for recurrent acute appendicitis. Another 6 patients have had an appendectomy due to recurrent abdominal pain (n = 5) or parental wish (n = 1) during the follow-up period; none of these 6 patients had evidence of appendicitis on histopathological examination.
  
  
  CONCLUSIONS
  Twenty-two of 24 patients (92%) treated with antibiotics had initial resolution of symptoms. Of these 22, only 1 patient (5%) had recurrence of acute appendicitis during follow-up. Overall, 62% of patients have not had an appendectomy during the follow-up period. This pilot trial suggests that nonoperative treatment of acute appendicitis in children is feasible and safe and that further investigation of nonoperative treatment is warranted.
authors: *Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden †Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden ‡Surgery Unit, UCL Institute of Child Health, London, United Kingdom §Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada ‖Department of Pediatric Surgery, Great Ormond Street Hospital, London, United Kingdom.
authors: Jan F
authors: JF
authors: Svensson
authors: Barbora
authors: B
authors: Patkova
authors: Markus
authors: M
authors: Almström
authors: Hussein
authors: H
authors: Naji
authors: Nigel J
authors: NJ
authors: Hall
authors: Simon
authors: S
authors: Eaton
authors: Agostino
authors: A
authors: Pierro
authors: Tomas
authors: T
authors: Wester
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D000077731:Meropenem; D008795:Metronidazole / Q000627:therapeutic use; D010865:Pilot Projects; D012008:Recurrence; D013845:Thienamycins / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D008795:Metronidazole; D002939:Ciprofloxacin; D000077731:Meropenem