Children with simple cases of appendicitis may be safely treated with antibiotics instead of surgery, suggests a new study.
Forgoing surgery to remove the appendix may not be an option for all kids, researchers say, but just three of 30 children who tried the antibiotics-only route ended up needing surgery.
"In this group of patients with uncomplicated appendicitis - in the people we studied, non-operative management with antibiotics alone appears to be a reasonable alternative," Dr. Peter Minneci told Reuters Health.
He is the study's lead author, from Nationwide Children's Hospital in Columbus, Ohio.
Appendicitis is when the appendix, a small tube-shaped extension of the colon, becomes inflamed and filled with puss. The appendix may burst without treatment and cause a widespread infection.
Although the cause of appendicitis is not known, Minneci said it may often occur when a piece of feces blocks the appendix and allows bacteria to proliferate. Other inflamed tissues may also block the appendix and cause the condition.
"It used to be that people would operate on appendixes in the middle of the night," he said. "Then we found that it was safe to give them antibiotics and operate on them in the morning."
Doctors began noticing that some of the children were feeling better in the morning after the initial treatment of antibiotics.
"They were hungry and they didn't have pain anymore," Minneci said.
To see whether antibiotics alone might be enough to treat appendicitis, he and his colleagues enrolled 77 children and teens brought to the emergency room at Nationwide Children's Hospital from October 2012 to October 2013.
All the participants had been diagnosed with uncomplicated acute appendicitis. Their appendixes had not burst, were not overly swollen and imaging did not show a hard piece of stool blocking the organ.
Those uncomplicated cases represent about one in five appendicitis cases at the hospital, the researchers note in the Journal of the American College of Surgeons.
The participants and their families were allowed to choose between surgery or receiving 24 hours of intravenous antibiotics in the hospital followed by 10 days of antibiotics in pill form after they went home.
"We do believe patients should be admitted to the hospital and watched," Minneci said. "They shouldn't just get antibiotics and be sent home."
Of the 77 participants, 30 chose antibiotics and 47 picked surgery.
Of those who chose the antibiotic option, 93 percent were feeling better within a day. They also tended to recover faster.
Kids in the antibiotics-only group had