title: Nonoperative treatment of acute appendicitis in children: A feasibility study.
abstract: OBJECTIVE
  Nonoperative treatment of acute appendicitis appears to be feasible in adults. It is unclear whether the same is true for children.
  
  
  METHODS
  Children 5-18 years with <48 h symptoms of acute appendicitis were offered nonoperative treatment: 2 doses of piperacillin IV, then ampicillin/clavulanate ×1 week. Treatment failure (worsening on therapy) and recurrence (after completion of therapy) were noted. Patients who declined enrollment were asked to participate as controls. Cost-utility analysis was performed using Pediatric Quality of Life Scale (PedsQL®) to calculate quality-adjusted life month (QALM) for study and control patients.
  
  
  RESULTS
  Twenty-four patients agreed to undergo nonoperative management, and 50 acted as controls. At a mean follow-up of 14 months, three of the 24 failed on therapy, and 2/21 returned with recurrent appendicitis at 43 and 52 days, respectively. Two patients elected to undergo an interval appendectomy despite absence of symptoms. Appendectomy-free rate at one year was therefore 71% (C.I. 50-87%). No patient developed perforation or other complications. Cost-utility analysis shows a 0.007-0.03 QALM increase and a $1359 savings from $4130 to $2771 per nonoperatively treated patient.
  
  
  CONCLUSIONS
  Despite occasional late recurrences, antibiotic-only treatment of early appendicitis in children is feasible, safe, cost-effective and is experienced more favorably by patients and parents.
authors.affiliation: Division of Pediatric Surgery Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI.
authors.forename: Joseph
authors.initials: J
authors.lastname: Hartwich
authors.affiliation: Division of Pediatric Surgery Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI. Electronic address: Francois_Luks@brown.edu.
authors.forename: Francois I
authors.initials: FI
authors.lastname: Luks
authors.affiliation: Division of Pediatric Surgery Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI.
authors.forename: Debra
authors.initials: D
authors.lastname: Watson-Smith
authors.affiliation: Division of Pediatric Surgery Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI.
authors.forename: Arlet G
authors.initials: AG
authors.lastname: Kurkchubasche
authors.affiliation: Division of Pediatric Surgery Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Muratore
authors.affiliation: Division of Pediatric Surgery Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI.
authors.forename: Hale E
authors.initials: HE
authors.lastname: Wills
authors.affiliation: Division of Pediatric Surgery Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Tracy
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy / Q000191:economics; D001064:Appendicitis / Q000188:drug therapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011788:Quality of Life; D012008:Recurrence; D017211:Treatment Failure; D065093:beta-Lactamase Inhibitors / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D065093:beta-Lactamase Inhibitors; D000077725:Piperacillin, Tazobactam Drug Combination; D019980:Amoxicillin-Potassium Clavulanate Combination; D010397:Penicillanic Acid; D010878:Piperacillin
keywords: Antibiotics; Appendectomy; Appendicitis; Cost-utility analysis; Nonoperative treatment