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Antibiotics could be used to treat appendicitis

Study suggests antibiotics may offer non-surgical option for appendicitis in children

Ingrid Torjesen

Friday, 17 February 2017

A course of antibiotics could be used as an alternative to appendicectomy for the treatment of acute non-complicated appendicitis in children, a study* published in Pediatrics suggests.

Researchers at the University of Southampton conducted a literature review and identified 10 studies published over the past 10 years reporting on 413 children who received non-operative treatment rather than an appendicectomy.

None of the studies reported any safety concern or specific adverse events related to non-surgical treatment, although the rate of recurrent appendicitis was 14%.

Nigel Hall, Associate Professor of Paediatric Surgery at the University of Southampton, who led the research, said: "Acute appendicitis is one of the most common general surgical emergencies worldwide and surgery has long been the gold standard of treatment. But it is invasive and costly, not to mention extremely daunting for the child concerned and their family. Our review shows that antibiotics could be an alternative treatment method for children. When we compared the adult literature to the data in our review it suggested that antibiotic treatment of acute appendicitis is at least as effective in children as in adults. This now needs to be explored more widely."

The researchers concluded that longer-term clinical outcomes and cost effectiveness of antibiotics compared to appendicectomy required further evaluation, preferably as large randomised trials to reliably inform decision making.

The University of Southampton team, along with colleagues at St George's Hospital in Tooting, Alder Hey Children's Hospital in Liverpool and Great Ormond Street Hospital, are now carrying out a year-long feasibility trial which will see children with appendicitis randomly allocated to have either surgery or antibiotic treatment.

Mr Hall, also Consultant Paediatric and Neonatal Surgeon at Southampton Children's Hospital, said: "In our initial trial, we will see how many patients and families are willing to join the study and will look at how well children in the study recover.

"This will give us an indication of how many children we may be able to recruit into a future larger trial and how the outcomes of non-operative treatment compare with an operation."

The study, known as CONservative TReatment of Appendicitis in Children a randomised controlled Trial (CONTRACT), is being funded through a £483,000 grant from the National Institute for Health Research Health Technology Assessment Programme and co-ordinated by the University of Southampton's clinical trials unit in collaboration with the University of Bristol, the University of Liverpool and University College London.

* Georgiou R, Eaton S, Stanton MP, et al. Efficacy and safety of nonoperative treatment for acute appendicitis: a meta-analysis. Pediatrics, February 2017

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