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
Hauptverfasser: Steiner, Zvi, Buklan, Genady, Gutermacher, Michael, Litmanovitz, Ita, Landa, Tal, Arnon, Shmuel
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container_end_page 288
container_issue 3
container_start_page 283
container_title Pediatric surgery international
container_volume 34
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
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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. 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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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