“It has become clear in recent years that in adults there are some patients with appendicitis who can recover from the disease without an operation,” said Nigel Hall, associate professor at the University of Southampton in the UK.
“We are frequently asked by parents of children with appendicitis whether their child really needs an operation to get better.”
Antibiotics alone effective for 97% of childrenThe study reviewed ten studies published within the past decade consisting of 413 children who received non-operative treatment rather than an appendicectomy. Overall, the antibiotics alone were found to be effective for 97% of children who received non-surgical treatment, and the rate of recurrent appendicitis was 14%. However, no study reported any safety concerns or specific adverse events related to the treatment.
“Although surgery remains the “gold standard” tried and tested treatment, it is invasive and costly, not to mention extremely daunting for the children and their family,” said Hall, “we are keen to explore the role of non-operative treatment for these children.”
A Swedish study concluded that antibiotics alone are a satisfactory way to treat mild to moderate appendicitis without complications. The 24% rate of recurrence is not considered high and the choice of recurred appendicitis treatment depends on individual patients.
“While the benefit of non-operative treatment might be that you can avoid an operation, if you get a recurrence of your appendicitis it is likely that you will then be recommended to have an operation to remove the appendix in the long run,” said Hall. “So the benefit of avoiding an operation in the short term is gone.”
Concerns of antibiotic’s efficacy and threat of resistanceMeanwhile, the Australian Academy of Science is seeking a solution on the worldwide issue of antimicrobial resistance. More and more cases have cropped up, edging nearer to a crisis evidenced by a case where a woman died from a superbug resistant to all antibiotics available in the US.
Furthermore, bacteria in Southeast Asian hospitals are also found to have higher rate of resistance to carbapenems, the last-resort antibiotics, as compared to the European and North American counterparts. Hence, the issue is whether antibiotic prescription for appendicitis will add to the growing resistance problem.
As only one of the ten studies in the review considered randomised control trials, further evaluation, preferably in large randomised trials, is needed to compare the effectiveness of antibiotics alone versus appendicectomy, as well as to evaluate costs and quality of life for the different treatments.
Anthony Lander, a consultant surgeon at Birmingham Women’s and Children’s Hospital who was not involved in the study, acknowledged that both surgery and antibiotics alone have their benefits and drawbacks.
“Operations are expensive and have complications but there is no recurrent appendicitis. Antibiotics are cheap and very safe but may fail to treat the illness and surgery may still be required,” he said. MIMS
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