Successful Nonoperative Management of Uncomplicated Acute Appendicitis with Antibiotic Therapy

F. Bruder Stapleton, MD

90% of children managed nonoperatively had no progression within 30 days.

Urgent appendectomy has been the mainstay of therapy for acute appendicitis. A nonrandomized, prospective trial compared two therapies determined by parental choice: intravenous piperacillin-tazobactam or ciprofloxacin/metronidazole therapy for at least 24 hours followed by oral antibiotics for 10 days (30 children) versus appendectomy (47 children).

Patients were between ages 7 and 17 years, with ≤48 hours of abdominal pain, white blood cell counts <18,000/µL, and no radiographic evidence of rupture, abscess, or appendiceal fecalith. Immediate and 30-day success rates for nonoperative management were 93% and 90%, respectively. None of the three patients who progressed and underwent subsequent appendectomy had a ruptured appendix. Nonoperative management was associated with significantly longer length of stay (38 vs. 20 hours), but shorter delay before return to school (3 vs. 5 days) and higher scores on parent assessment of child quality of life.

Citation(s):

Minneci PC et al. Feasibility of a nonoperative management strategy for uncomplicated acute appendicitis in children. J Am Coll Surg 2014 Apr 12; [e-pub ahead of print].