How Safe is Medical Tx for Pediatric Appendicitis?

Action Points

  • Note that this meta-analysis demonstrates that for children with acute appendicitis, antibiotic treatment (without surgery) has a high incidence of treatment failure.
  • Be aware that only one of the studies included in this meta-analysis was a randomized trial.

While antibiotics to treat acute uncomplicated pediatric appendicitis were both safe and effective, the risk of treatment failure was still substantially higher than with surgery, according to a small meta-analysis.

Non-operative treatment was successful in 90.5% of patients, ages 5 to 18 years, in five examined studies, with 9.5% of patients either requiring an appendectomy within 48 hours or a recurrence of appendicitis within a month, reported Libin Huang, MD, of Sichuan University in China, and colleagues.

However, those patients treated with antibiotics were still nearly nine times as likely to experience treatment failure, albeit with a wide confidence interval (Mantel-Haenszel fixed-effects risk ratio 8.92, 95% CI 2.67-29.79, heterogeneity, P=0.99, I2=0%), the authors wrote in JAMA Pediatrics.

But they also noted that the presence of appendicolith, or a calcified deposit within the appendix, greatly increased the risk of non-surgical treatment failure.

The authors said that while a number of randomized trials have shown that non-operative treatment with antibiotics is safe and effective for adults with uncomplicated appendicitis, these results are not applicable to pediatric patients.

“Owing to specific anatomical and…

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