Conservative antibiotic treatment for acute uncomplicated appendicitis is feasible
Purpose Appendectomy versus conservative antibiotic treatment (CAT) for children with acute uncomplicated appendicitis (AUA) remains unresolved, with concerns regarding the practicality of CAT. We analyzed our center’s experience with CAT for AUA, using a protocol with strict inclusion, exclusion an...
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Veröffentlicht in: | Pediatric surgery international 2018-03, Vol.34 (3), p.283-288 |
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creator | Steiner, Zvi Buklan, Genady Gutermacher, Michael Litmanovitz, Ita Landa, Tal Arnon, Shmuel |
description | Purpose
Appendectomy versus conservative antibiotic treatment (CAT) for children with acute uncomplicated appendicitis (AUA) remains unresolved, with concerns regarding the practicality of CAT. We analyzed our center’s experience with CAT for AUA, using a protocol with strict inclusion, exclusion and treatment criteria.
Methods
Non-randomized, prospective cohort study included all children admitted betwee 2014 and 2016, with clinical and laboratory tests suspicious for AUA. Data collected included clinical signs and symptoms; laboratory, ultrasound and pathology results. Follow-up was conducted through clinic visits, telephone conversations and national registry analysis.
Results
Included in CAT: 362 children, 19 underwent appendectomy within 1–2 days. Overall, 75 were readmitted for recurrent acute appendicitis during 22 months (6–43) follow-up. Thirty were treated successfully with antibiotics a second time. The remaining 45 had appendectomy. Overall, 86.8% underwent CAT with no surgery. Histology of all recurrent AUA revealed no perforations.
Conclusion
We confirm the feasibility of conservative management of AUA in children. A rigorous diagnostic plan with strict inclusion and exclusion criteria will lead to high success rate of CAT with a strong safety profile. CAT does not compete with surgery or render appendectomy unnecessary. It is a safe alternative to surgery in selected cases. |
doi_str_mv | 10.1007/s00383-018-4226-4 |
format | Article |
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Appendectomy versus conservative antibiotic treatment (CAT) for children with acute uncomplicated appendicitis (AUA) remains unresolved, with concerns regarding the practicality of CAT. We analyzed our center’s experience with CAT for AUA, using a protocol with strict inclusion, exclusion and treatment criteria.
Methods
Non-randomized, prospective cohort study included all children admitted betwee 2014 and 2016, with clinical and laboratory tests suspicious for AUA. Data collected included clinical signs and symptoms; laboratory, ultrasound and pathology results. Follow-up was conducted through clinic visits, telephone conversations and national registry analysis.
Results
Included in CAT: 362 children, 19 underwent appendectomy within 1–2 days. Overall, 75 were readmitted for recurrent acute appendicitis during 22 months (6–43) follow-up. Thirty were treated successfully with antibiotics a second time. The remaining 45 had appendectomy. Overall, 86.8% underwent CAT with no surgery. Histology of all recurrent AUA revealed no perforations.
Conclusion
We confirm the feasibility of conservative management of AUA in children. A rigorous diagnostic plan with strict inclusion and exclusion criteria will lead to high success rate of CAT with a strong safety profile. CAT does not compete with surgery or render appendectomy unnecessary. It is a safe alternative to surgery in selected cases.</description><identifier>ISSN: 0179-0358</identifier><identifier>EISSN: 1437-9813</identifier><identifier>DOI: 10.1007/s00383-018-4226-4</identifier><identifier>PMID: 29344678</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Antibiotics ; Appendectomy ; Appendicitis ; Laboratories ; Medicine ; Medicine & Public Health ; Original Article ; Pediatric Surgery ; Pediatrics ; Surgery</subject><ispartof>Pediatric surgery international, 2018-03, Vol.34 (3), p.283-288</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>Pediatric Surgery International is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-a4ecf571d5cc57bc350e7cdf41acfbb1ee1c0bb12e60930c5fea721827606643</citedby><cites>FETCH-LOGICAL-c372t-a4ecf571d5cc57bc350e7cdf41acfbb1ee1c0bb12e60930c5fea721827606643</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00383-018-4226-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00383-018-4226-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29344678$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Steiner, Zvi</creatorcontrib><creatorcontrib>Buklan, Genady</creatorcontrib><creatorcontrib>Gutermacher, Michael</creatorcontrib><creatorcontrib>Litmanovitz, Ita</creatorcontrib><creatorcontrib>Landa, Tal</creatorcontrib><creatorcontrib>Arnon, Shmuel</creatorcontrib><title>Conservative antibiotic treatment for acute uncomplicated appendicitis is feasible</title><title>Pediatric surgery international</title><addtitle>Pediatr Surg Int</addtitle><addtitle>Pediatr Surg Int</addtitle><description>Purpose
Appendectomy versus conservative antibiotic treatment (CAT) for children with acute uncomplicated appendicitis (AUA) remains unresolved, with concerns regarding the practicality of CAT. We analyzed our center’s experience with CAT for AUA, using a protocol with strict inclusion, exclusion and treatment criteria.
Methods
Non-randomized, prospective cohort study included all children admitted betwee 2014 and 2016, with clinical and laboratory tests suspicious for AUA. Data collected included clinical signs and symptoms; laboratory, ultrasound and pathology results. Follow-up was conducted through clinic visits, telephone conversations and national registry analysis.
Results
Included in CAT: 362 children, 19 underwent appendectomy within 1–2 days. Overall, 75 were readmitted for recurrent acute appendicitis during 22 months (6–43) follow-up. Thirty were treated successfully with antibiotics a second time. The remaining 45 had appendectomy. Overall, 86.8% underwent CAT with no surgery. Histology of all recurrent AUA revealed no perforations.
Conclusion
We confirm the feasibility of conservative management of AUA in children. A rigorous diagnostic plan with strict inclusion and exclusion criteria will lead to high success rate of CAT with a strong safety profile. CAT does not compete with surgery or render appendectomy unnecessary. It is a safe alternative to surgery in selected cases.</description><subject>Antibiotics</subject><subject>Appendectomy</subject><subject>Appendicitis</subject><subject>Laboratories</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Pediatric Surgery</subject><subject>Pediatrics</subject><subject>Surgery</subject><issn>0179-0358</issn><issn>1437-9813</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp1kMtKxDAUQIMozvj4ADdScOOmepO0SbqUwRcMCOI-pOmtZOjLJBX8ezOMighC4C5ycnI5hJxRuKIA8joAcMVzoCovGBN5sUeWtOAyrxTl-2QJVFY58FItyFEIGwBQXFSHZMEqXhRCqiV5Xo1DQP9uonvHzAzR1W6MzmbRo4k9DjFrR58ZO0fM5sGO_dQ5ayI2mZkmHBpnXXQhS6dFE1zd4Qk5aE0X8PRrHpOXu9uX1UO-frp_XN2sc8sli7kp0LalpE1pbSlry0tAaZu2oMa2dU0RqYU0GQqoONgy-SWjikkBQhT8mFzutJMf32YMUfcuWOw6M-A4B00rVZWqYgISevEH3YyzH9JyiUpuIYCxRNEdZf0YgsdWT971xn9oCnrbW-9669Rbb3vr7RLnX-a57rH5efEdOAFsB4R0Nbyi__X1v9ZP49-L9A</recordid><startdate>20180301</startdate><enddate>20180301</enddate><creator>Steiner, Zvi</creator><creator>Buklan, Genady</creator><creator>Gutermacher, Michael</creator><creator>Litmanovitz, Ita</creator><creator>Landa, Tal</creator><creator>Arnon, Shmuel</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20180301</creationdate><title>Conservative antibiotic treatment for acute uncomplicated appendicitis is feasible</title><author>Steiner, Zvi ; Buklan, Genady ; Gutermacher, Michael ; Litmanovitz, Ita ; Landa, Tal ; Arnon, Shmuel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-a4ecf571d5cc57bc350e7cdf41acfbb1ee1c0bb12e60930c5fea721827606643</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Antibiotics</topic><topic>Appendectomy</topic><topic>Appendicitis</topic><topic>Laboratories</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Pediatric Surgery</topic><topic>Pediatrics</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Steiner, Zvi</creatorcontrib><creatorcontrib>Buklan, Genady</creatorcontrib><creatorcontrib>Gutermacher, Michael</creatorcontrib><creatorcontrib>Litmanovitz, Ita</creatorcontrib><creatorcontrib>Landa, Tal</creatorcontrib><creatorcontrib>Arnon, Shmuel</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric surgery international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Steiner, Zvi</au><au>Buklan, Genady</au><au>Gutermacher, Michael</au><au>Litmanovitz, Ita</au><au>Landa, Tal</au><au>Arnon, Shmuel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Conservative antibiotic treatment for acute uncomplicated appendicitis is feasible</atitle><jtitle>Pediatric surgery international</jtitle><stitle>Pediatr Surg Int</stitle><addtitle>Pediatr Surg Int</addtitle><date>2018-03-01</date><risdate>2018</risdate><volume>34</volume><issue>3</issue><spage>283</spage><epage>288</epage><pages>283-288</pages><issn>0179-0358</issn><eissn>1437-9813</eissn><abstract>Purpose
Appendectomy versus conservative antibiotic treatment (CAT) for children with acute uncomplicated appendicitis (AUA) remains unresolved, with concerns regarding the practicality of CAT. We analyzed our center’s experience with CAT for AUA, using a protocol with strict inclusion, exclusion and treatment criteria.
Methods
Non-randomized, prospective cohort study included all children admitted betwee 2014 and 2016, with clinical and laboratory tests suspicious for AUA. Data collected included clinical signs and symptoms; laboratory, ultrasound and pathology results. Follow-up was conducted through clinic visits, telephone conversations and national registry analysis.
Results
Included in CAT: 362 children, 19 underwent appendectomy within 1–2 days. Overall, 75 were readmitted for recurrent acute appendicitis during 22 months (6–43) follow-up. Thirty were treated successfully with antibiotics a second time. The remaining 45 had appendectomy. Overall, 86.8% underwent CAT with no surgery. Histology of all recurrent AUA revealed no perforations.
Conclusion
We confirm the feasibility of conservative management of AUA in children. A rigorous diagnostic plan with strict inclusion and exclusion criteria will lead to high success rate of CAT with a strong safety profile. CAT does not compete with surgery or render appendectomy unnecessary. It is a safe alternative to surgery in selected cases.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>29344678</pmid><doi>10.1007/s00383-018-4226-4</doi><tpages>6</tpages></addata></record> |
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subjects | Antibiotics Appendectomy Appendicitis Laboratories Medicine Medicine & Public Health Original Article Pediatric Surgery Pediatrics Surgery |
title | Conservative antibiotic treatment for acute uncomplicated appendicitis is feasible |
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