Study finds some can use antibiotics to avoid an appendectomy

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Thousands of children who undergo appendectomies each year could avoid the operation by treating their inflamed appendices with antibiotics, according to a new study.

Published Wednesday  in JAMA Surgery, the research focused on kids with early appendicitis - meaning they have experienced pain for no more than two days and their appendix has not burst. They account for about one-quarter of the 70,000 children who undergo appendectomies in the U.S. each year, according to the study.

The researchers recruited 102 patients between the ages of 7 and 17 with early appendicitis who arrived at Nationwide Children's Hospital in Columbus, Ohio between October 2012 and March 2013.

Their parents were given two options: The children could undergo a laparoscopic appendectomy, or they could be admitted to the hospital and administered intravenous antibiotics for a minimum of 24 hours, followed by a 10-day course of oral antibiotics at home.

While 65 underwent surgery, 37 chose the antibiotics. Two of the patients who took antibiotics were readmitted to the hospital within 30 days and underwent laparoscopic appendectomies. But after one year, about 75 percent of the kids who took antibiotics – or 28 out of 37 – had not undergone an appendectomy.

The researchers found no difference in the rate of more advanced appendicitis between those who chose surgery initially and those who received antibiotics.

The study also found that treating early appendicitis with antibiotics is associated with lower health costs and fewer missed days of school and work for children and parents.

"We're not saying that antibiotics alone should replace surgery" for children with early appendicitis, says Dr. Peter Minneci, an assistant professor of surgery at Nationwide Children's Hospital and a study co-author.

"What we really believe is that they're both reasonable treatment options and that you should really let the families choose which one is best for them and their child," he says.

The appendectomy is curative, but also an invasive procedure requiring general anesthesia that comes with some risks.

Treating appendicitis with antibiotics, meanwhile, is a relatively new idea or, as Minneci puts it, "an old idea that's now come back." He explains that the condition was treated this way "before surgery became very safe," and is currently used in the military on the battlefield and in submarines.

Minneci says his research builds on studies conducted in Europe that found this antibiotic method can be safe and effective for adults and children. He undertook this study, he says, to answer the question of whether it is "effective enough to make it worth offering to patients."

Based on the results of the study, Minecci says that the antibiotic approach is "a reasonable treatment option to offer to both kids and adults" with early appendicitis. In fact, he and his partners at Nationwide Children's Hospital have included antibiotic treatment as an option for patients with early appendicitis.