• Posted December 2, 2024

Antibiotics or Surgery: What's Best for Child Appendicitis?

For decades, surgery to remove an inflamed appendix has been a rite of childhood for many.

But a new study says treating appendicitis with antibiotics, rather than surgery, is the best way to address most cases.

Using antibiotics to treat uncomplicated cases of appendicitis resulted in less pain and fewer days off from school for kids, researchers report in the Journal of the American College of Surgeons.

It’s also more cost-effective than appendectomy, results reveal.

“This cost analysis demonstrates that nonoperative management for pediatric uncomplicated acute appendicitis is the most cost-effective management strategy over one year, compared to upfront surgery,” researcher Dr. Peter Minneci, chair of surgery at Nemours Children’s Health in Wilmington, Del., said in a news release.

Appendicitis is the fifth most common reason for hospitalization among U.S. children, researchers said in background notes. Appendectomy is the most common surgical procedure performed on hospitalized children.

For this study, researchers analyzed data on more than 1,000 7- to 17-year-olds treated for uncomplicated appendicitis at several Midwest hospitals between 2015 and 2018.

Parents were given the choice of having their child’s appendix removed, or to have them treated with IV antibiotics for at least 24 hours to see if surgery could be avoided.

Nearly two-thirds (65%) of parents opted for surgery over antibiotics, researchers said.

But those kids given antibiotics wound up with slightly better quality-of-life than those treated surgically, results showed. 

Antibiotic treatment also was cheaper, costing just $8,044 on average compared with $9,791 for appendectomy.

“Our study findings add an additional benefit to the antibiotics-only approach being safe and effective for children in that this strategy is shown to be cost effective,” Minneci said. “In short, nonoperative management is a safe and cost-effective initial therapy and a reasonable alternative to surgery.”

The researchers next plan to compare how often each form of treatment fails, and whether antibiotics could be given to kids with appendicitis at home rather than in the hospital.

More information

The National Institutes of Health has more on appendicitis.

SOURCE: American College of Surgeons, news release, Nov. 26, 2024