Acute appendicitis in children has always been considered a surgical emergency. However, children who have uncomplicated appendicitis may be effectively treated with antibiotic therapy, according to a meta-analysis that compared this treatment option with appendectomy. Several studies have already shown that uncomplicated appendicitis in adults can be managed safely and effectively with antibiotics.

The meta-analysis included five studies published in 2015 and 2016, involving a total of 404 patients who were five to 18 years old. All patients had uncomplicated nonperforated acute appendicitis. In one of the five studies, patients had been randomly assigned to receive either antibiotics or appendectomy. In the other four, the treatment had been selected by the parents.

Antibiotic treatment was considered successful if symptoms resolved without the need for surgery within 48 hours or if there was no recurrence of appendicitis within a month of hospital discharge. Operative treatment was successful if surgery did not result in a negative appendectomy finding and/or the need for reoperation. Initial treatment failed in 16 of the 168 (9.5%) patients treated with antibiotics, requiring appendectomy within 48 hours (11 patients) or one month (five patients). None of the 236 surgically treated patients had a negative appendectomy, and one had a complication requiring reoperation.

Within one year, 45 of the 168 patients (26.8%) in the antibiotic group had undergone appendectomy because of initial treatment failure or recurrence. The presence of an appendicolith-a calcified deposit in the appendix seen in about 10% of patients with appendicitis-greatly increased the risk of antibiotic treatment failure and, in fact, was the main cause of this type of failed treatment. Antibiotic treatment failed in 50% of patients with appendicolith, resulting in the need for appendectomy.

The authors conclude that pediatric patients presenting with uncomplicated, acute appendicitis without appendicolith can effectively be treated initially with antibiotics rather than surgery.

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