A role for conservative antibiotic treatment in early appendicitis in children.
OBJECTIVE
To evaluate whether antibiotics without surgery is sufficient treatment for children with clinically and ultrasonographically suspected acute appendicitis (AA).


METHODS
Children with clinical, laboratory and radiological findings suspicious for AA were evaluated prospectively. Patients with mild clinical signs, without peritonitis were considered for IV followed by oral antibiotics without surgery.


RESULTS
From 1 November 2013 through 30 June 2014, 45 children were diagnosed with early, acute appendicitis. Ages ranged from 4 to 15 years (mean 9.3) and 32 (75%) were boys. All had routine, clinical laboratory and ultrasound workup. Forty-two improved with antibiotic treatment and were discharged home within 3-5 days, without surgery. Three of them were operated on within 24 hours, another two underwent appendectomy for recurrent appendicitis: one at 2 weeks and the other 2 months after discharge. There was no more recurrent appendicitis in 6-14-month follow-up.


CONCLUSIONS
Our series of patients with AA treated with antibiotics only are a product of the observation that some children improve with antibiotics alone at a stage in which surgery is still debatable. These results (89% success rate) support the conservative approach in cases of early appendicitis, without increased morbidity in failed cases.
Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel; Tel Aviv University, Tel Aviv, Israel. Electronic address: zvi.steiner@clalit.org.il.
Zvi
Z
Steiner
Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel; Tel Aviv University, Tel Aviv, Israel.
Genady
G
Buklan
Tel Aviv University, Tel Aviv, Israel; Department of Radiology, Meir Medical Center, Kfar Saba, Israel.
Rodica
R
Stackievicz
Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel; Tel Aviv University, Tel Aviv, Israel.
Michael
M
Gutermacher
Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel; Tel Aviv University, Tel Aviv, Israel.
Ilan
I
Erez
D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001064:Appendicitis / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Antibiotics; Appendicitis; Conservative treatment