Antibiotic Management for Acute Appendicitis in Children: Is it Worth it?

Introduction: Surgical management of appendicitis in children can reduce its mortality rate, but the risk of complications is comparable. The most common risks in post-operative appendectomy are surgical wound infections, intra-abdominal abscess, and prolonged ileus. The inflammation of the appendix will not always end in perforation because it may resolve spontaneously. This is the result of using antibiotics to reduce the inflammation. The discovery accounts for the decreased appendectomy surgeries. These are the basis for us to conduct research on the use of antibiotics rather than surgery, in appendicitis. Objective: To determine the effect of antibiotic treatments in pediatric appendicitis to prevent surgery. Methods: A prospective cohort method was used with a non-random consecutive sampling of 54 children from January 2015 to January 2016. The diagnosis of appendicitis is made based on clinical symptoms and laboratory results with abdominal tenderness, fever, nausea, vomiting, increased leukocyte and neutrophil count, and an abdominal ultrasound. We obtained 40 children (74.1%) diagnosed with non-complicated appendicitis and treated with two classes of antibiotics and one analgesic. 14 children (25.9%) had complicated appendicitis and received three classes of antibiotics with one analgesic. Each group was observed for 3-5 days of treatment. Results: The group of children with non-complicated appendicitis who resolved only with conservative treatment was 29 children (72.5%) with p value < 0.001. The group of children with complicated appendicitis who resolved with conservative treatment was only 1 child (7.1%) with p value<0.001. There was a significant reduction in pain for both groups (p value<0.001). Conclusion: The use of antibiotics as a type of treatment for non-complicated appendicitis has significant effect to reduce surgery. Its administration also significantly decreased pain in both complicated and non-complicated appendicitis. Further studies with larger sample size are needed to investigate the relationship between antibiotic treatments in pediatric appendicitis to prevent invasive interventions.