Researchers found that when families chose antibiotic treatment for
kids with simple appendicitis, instead of going immediately for
surgery, the children often recovered without ever needing surgery.
Kids were also out of commission for fewer days and ended up with a
smaller healthcare bill than those whose families picked surgery.
"There is a relatively good body of literature in adults and also in
children that shows patients and parents involved in the decision
process do better," said Dr. Peter Minneci, of The Research
Institute at Nationwide Childrenís Hospital in Columbus, Ohio.
Appendicitis occurs when the appendix, a small pouch of tissue off
the large intestine, becomes inflamed. The condition can be caused
by an infection, blockage, trauma or intestinal disorders like
About 11 percent of all pediatric emergency room visits are due to
appendicitis, Minneci and his colleagues write in JAMA Surgery.
Treatment historically has been surgery to remove the appendix,
known as appendectomy. But that comes with the possibility of other
complications and disruptions to family schedules while the patient
More recent research suggests that treating appendicitis with
intense regimens of antibiotics is also effective, but the people in
those trials were randomly assigned to receive either surgery or
antibiotics, they didn't get to choose their treatment.
"By allowing the patient to be involved in the decision process you
are allowing them to align their preference and beliefs with the
care themselves," Minneci told Reuters Health.
For the new study, the researchers screened 629 patients between
ages seven and 17 who came to their emergency room between October
2012 and March 2013 with appendicitis. About 22 percent didn't have
severe or complex cases of appendicitis and were eligible for the
Ultimately, 102 enrolled in the study. Of those, 37 families chose
to have their children treated with at least 24 hours of intravenous
antibiotics followed by 10 days of oral antibiotics. The others
A year later, about 76 percent of kids whose family chose
antibiotics were still healthy and didn't need additional treatment.
Compared to those who got surgery, the children who got antibiotics
also ended up needing an average of 13 fewer days of rest, and had
medical bills that were an average of $800 lower.
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There was also no significant difference in the number of
appendicitis cases that became complicated during surgery or after
treatment with antibiotics. Minneci said that shows the treatment
options are similar in terms of safety.
However, he said, the study team doesn't want to say one treatment
is better than the other, merely that treatment of simple cases of
appendicitis with antibiotics is a reasonable alternative.
An accompanying editorial cautions that more research is needed to
strike the right balance between patient preference and a doctor's
"Many patients still want us to be 'doctors,' not Google
impersonators," write Drs. Diana Lee Farmer and Rebecca Anne Stark,
of the University of California, Davis.
Dr. Russell Jennings told Reuters Health that it's important to note
that patients still need to see a surgeon regardless of the
treatment, because they need to be evaluated to see if antibiotics
are even an option.
"Itís important you donít change the quality of care," said
Jennings, a surgeon at Boston Children's Hospital in Massachusetts.
The option of antibiotics for simple appendicitis is likely already
available in large medical centers for adults with appendicitis and
probably a few large centers that treat children, said Jennings, who
wasn't involved in the new study.
Minneci said his hospital already offers the option of antibiotics
to people with simple cases of appendicitis, and he expects other
hospitals to start developing protocols to introduce the option,
"I think if a family walks in the ER now and they bring it up, the
surgeon should discuss it with them because itís a reasonable
option," he said.
SOURCE: http://bit.ly/1QsX4YH and http://bit.ly/1QsX8rA JAMA
Surgery, online December 16, 2015.
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