Antibiotics versus surgery in acute appendicitis

A systemic review of research literature by scientists at the University of Southampton shows that antibiotics may be an effective treatment for acute non-complicated appendicitis in children, instead of surgery. The research paper is published in Pediatrics.

The condition, which causes the appendix – a small organ attached to the large intestine – to become inflamed due to a blockage or infection, affects mainly children and teenagers. Appendicitis is currently treated through an operation to remove the appendix, known as an appendicectomy, and it is the most common cause of emergency surgery in children.

The review, led by Nigel Hall, Associate Professor of Pediatric Surgery at the University of Southampton, assessed existing literature published over the past 10 years that included 10 studies reporting on 413 children who received non-operative treatment rather than an appendectomy. It shows that no study reported any safety concern or specific adverse events related to non-surgical treatment, although the rate of recurrent appendicitis was 14 per cent.

The review says that longer term clinical outcomes and cost effectiveness of antibiotics compared to appendicectomy require further evaluation, preferably as large randomized trials to reliably inform decision making.

To further this research Mr. Hall and his team in Southampton, along with colleagues at St George’s Hospital in Tooting, Alder Hey Children’s Hospital in Liverpool and Great Ormond Street Hospital, are currently carrying out a year-long feasibility trial which will see children with appendicitis randomly allocated to have either surgery or antibiotic treatment.

Reference: Georgiou, Roxani, Simon Eaton, Michael P. Stanton, Agostino Pierro, and Nigel J. Hall. “Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis.” Pediatrics, 2017.
doi:10.1542/peds.2016-3003.
Research funding: National Institute for Health Research Health Technology Assessment Programme (UK).
Adapted from press release by University of Southampton.