Antibiotics gaining acceptance as potential alternative to pediatric appendectomy

Editor's Note

Evidence is mounting for the use of antibiotics as a valid alternative to surgery for acute appendicitis, including in pediatric cases, the Washington Post reported August 17.

The article details how this treatment—described as a “dark secret” by one expert testifying to its use in the 1950s, prior to extensive study—evolved to gain wider attention in the 1990s and 2000s, culminating in two large, randomized trials. Published in 2015 in Jama, the first showed only 27 percent of adults receiving antibiotic treatment required appendectomy within one year. The second, published in 2020 in the New England Journal of Medicine, showed similar results, with 29% requiring surgery within 90 days.

The report emphasizes the complexity of the decision. Surgery eliminates the risk of recurrence and allows for the discovery of potential underlying conditions, such as cancer. Antibiotics, while less invasive and potentially less costly, carry the risk of recurrence and may lead to more emergency room visits.

Pediatric cases are even more nuanced, The Post reports. A trial published in JAMA in 2020, conducted across 10 children’s hospitals, allowed parents to choose their child’s treatment.  Of 1,068 children with appendicitis, 35% took antibiotics, and of those, 33% required appendectomy. Another large trial—the first to randomize families to their treatment option—found that 33.8% of children treated with antibiotics underwent appendectomy afterwards.

Sources quoted in the article emphasize that both approaches carry benefits and risks, which must be weighed carefully by both patients and providers alike.