Colon and RectumInitial antibiotic treatment for acute simple appendicitis in children is safe: Short-term results from a multicenter, prospective cohort study
Section snippets
Design and setting
This multicenter, prospective cohort study was performed in 4 hospitals in The Netherlands, including 2 academic (tertiary referral) centers and 2 large peripheral hospitals. The study started in September (VU University Medical Centre, Amsterdam), November (Academic Medical Centre, Amsterdam), December 2012 (Red Cross Hospital, Beverwijk), and February 2014 (Flevoziekenhuis, Almere). Inclusion lasted until June 7, 2014. The medical ethics committee of the VU University medical center approved
Feasibility of the initial antibiotic strategy
During the study period, 117 children with acute appendicitis were examined at the emergency departments of the participating hospitals. Seventy-three did not fulfil the inclusion criteria. The main exclusion criterion was the complexity of appendicitis. In 23 patients, the appendix could not be visualized on ultrasonography and it was decided not to obtain additional imaging studies, but to admit these patients for observation or to perform a diagnostic laparoscopy.
Of the 44 patients who were
Discussion
This multicenter, prospective cohort study shows that a subsequent RCT comparing initial antibiotic treatment with acute appendectomy for acute simple appendicitis in children is feasible and safe. The initial antibiotic strategy (with an appendectomy in case of failure) was effective in all cases. In our study, almost all patients on initial antibiotic treatment did not need appendectomy within 8 weeks after initial antibiotic treatment. The 2 patients in whom eventually an appendectomy was
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Appendicitis in Children
2023, Advances in PediatricsImplementing Nonoperative Treatment Strategy for Simple Pediatric Appendicitis: A Qualitative Study
2022, Journal of Surgical ResearchCitation Excerpt :The medical research ethics committee of the Academic Medical Center, Amsterdam reviewed the protocol of the study (W17_131#17.151) and confirmed that the Dutch Medical Research Involving Human Subjects Act (WMO) did not apply and a full ethical review was not required. Recruitment of patients was done by telephone calls to patients who consented to be approached for further research in a previous study.12 All participants gave their written informed consent.
It's time to deconstruct treatment-failure: A randomized controlled trial of nonoperative management of uncomplicated pediatric appendicitis with antibiotics alone
2022, Journal of Pediatric SurgeryCitation Excerpt :As longer-term follow-up data from early trials emerge, the risk of recurrent appendicitis following antibiotic therapy has come to represent the single most clinically-relevant outcome in how success of this approach is defined. Recent prospective studies and meta-analyses show that management with antibiotics alone for uncomplicated appendicitis in children is feasible and safe, with success rates of 65–75% at 1 year, alongside decreases in lost school days, improved health-related quality of life (QOL) and high parental satisfaction [7–14]. However, many studies are limited by some degree of selection bias due to nonrandom treatment assignments.
Clinical trials
2018, Seminars in Pediatric SurgeryCitation Excerpt :The perspectives of the patient, their family, and the treating clinicians are all important components of shared decision-making that can impact outcomes positively. In the example of non-operative management of appendicitis, available data supports the efficacy and safety of antibiotics alone as an initial treatment for uncomplicated appendicitis in both children and adults.43,45–67 The goals of ongoing and future trials are to generate results reflective of outcomes of non-operative management in clinical practice.
Outcome of initially nonoperative treatment for acute simple appendicitis in children
2018, Journal of Pediatric SurgeryCitation Excerpt :Initially nonoperative treatment strategy consisted of intravenous administration of antibiotics with in-hospital monitoring, diet restriction and pain medication as needed. Study procedure is discussed in more detail in the original manuscript [7]. Immediate appendectomy group.
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