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Antibiotics could be alternative to surgery for appendicitis

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Antibiotics may be an effective treatment for acute non-complicated appendicitis in children, instead of surgery, according to UK researchers.

Appendicitis, currently routinely treated with an appendicectomy, is the most common cause of emergency surgery in children, noted the researchers.

“Antibiotics could be an alternative treatment method for children”

Nigel Hall

They assessed existing research literature published over the past 10 years that included 10 studies reporting on 413 children who received non-operative treatment rather than an appendectomy.

No study reported any safety concern or specific adverse events related to non-surgical treatment, although the rate of recurrent appendicitis was 14%, said the authors in the journal Pediatrics.

Lead author Nigel Hall, associate professor of paediatric surgery at Southampton University, said: “Acute appendicitis is one of the most common general surgical emergencies worldwide and surgery has long been the gold standard of treatment.

“But it is invasive and costly, not to mention extremely daunting for the child concerned and their family,” said Mr Hall, who is also a consultant paediatric and neonatal surgeon at Southampton Children’s Hospital.

“Our review shows that antibiotics could be an alternative treatment method for children,” he said. “When we compared the adult literature to the data in our review it suggested that antibiotic treatment of acute appendicitis is at least as effective in children as in adults. This now needs to be explored more widely.”

Mr Hall, along with colleagues in Liverpool and London, were now carrying out a year-long feasibility trial that will see children with appendicitis allocated to have either surgery or antibiotic.

The study – known as CONservative TReatment of Appendicitis in Children a randomised controlled Trial (CONTRACT) – is being funded through a £483,000 grant from the National Institute for Health Research’s health technology assessment programme.

It is being co-ordinated by the University of Southampton’s clinical trials unit in collaboration with the University of Bristol, the University of Liverpool and University College London.

Mr Hall said: “In our initial trial, we will see how many patients and families are willing to join the study and will look at how well children in the study recover.

“This will give us an indication of how many children we may be able to recruit into a future larger trial and how the outcomes of non-operative treatment compare with an operation,” he said.

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