Introduction. Recent studies on adult populations have ana-lyzed the efficacy of antibiotic therapy (AT) as first-line non-operative intervention for acute appendicitis (AA). To date, there is little experience about non-surgical management of AA in pediatric population. Our main objective was to evaluate the efficacy of a broad-spectrum AT compared to appendectomy in children with uncomplicated AA. Materials and Methods. Children diagnosed with uncomplicated AA were stratified according to clinical and ultrasonographic parameters and then randomized to receive surgical (appendicectomy) or medical (ev ceftazidime and metronidazole followed by oral ciprofloxacine and metronidazole) treatment. Short- and long-term outcomes of each patient were recorded. Results. 126 children (61 boys, 65 girls; mean age±SD: 115.6±32.1 months) were enrolled. According to the randomization protocol, 52 children were assigned to receive AT and 74 children under-went appendectomy. AT was effective in 49/52 (94.2%) chil-dren. Children treated with AT presented an overall recurrence rate of 12.2% during the first year after AA and showed a sig-nificant association between pARC score and poor outcome (lack of antibiotic efficacy or recurrence of appendicitis) (p: 0.04). Of note, children with pARC score <75 points had a 93% chance of having a favorable response to AT. Moreover, at the first follow-up 1 month after the AA episode, the thickening of perivisceral fat found on ultrasound examination was directly related to the long-term recurrence of appendicitis (p<0.05).Conclusions. The main result of our study is the high efficacy rate of AT in children with uncomplicated AA, which is com-parable to appendicectomy efficacy rate. However, children treated with AT showed a non-negligible AA relapse rate in the first year of follow-up, which resulted in the need for surgical treatment. The pARC score may help identifying children who will more likely benefit from a non-operative intervention.
Acute appendicitis in pediatric age: medical vs surgical therapy / Quitadamo, Paolo; Muzi, Giulia; Gaglione, Giovanni; Grella, Giovanna; Esposito, Marina; Argenziano, Gioconda; Ferrara, Dolores; Esposito, Francesco; DI NARDO, Giovanni; Parisi, Pasquale. - In: PEDIATRIA MEDICA E CHIRURGICA. - ISSN 0391-5387. - 45:N. s3(2023), pp. 19-19.
Acute appendicitis in pediatric age: medical vs surgical therapy
Giulia Muzi;Marina Esposito;Francesco Esposito;Giovanni Di Nardo;Pasquale Parisi
2023
Abstract
Introduction. Recent studies on adult populations have ana-lyzed the efficacy of antibiotic therapy (AT) as first-line non-operative intervention for acute appendicitis (AA). To date, there is little experience about non-surgical management of AA in pediatric population. Our main objective was to evaluate the efficacy of a broad-spectrum AT compared to appendectomy in children with uncomplicated AA. Materials and Methods. Children diagnosed with uncomplicated AA were stratified according to clinical and ultrasonographic parameters and then randomized to receive surgical (appendicectomy) or medical (ev ceftazidime and metronidazole followed by oral ciprofloxacine and metronidazole) treatment. Short- and long-term outcomes of each patient were recorded. Results. 126 children (61 boys, 65 girls; mean age±SD: 115.6±32.1 months) were enrolled. According to the randomization protocol, 52 children were assigned to receive AT and 74 children under-went appendectomy. AT was effective in 49/52 (94.2%) chil-dren. Children treated with AT presented an overall recurrence rate of 12.2% during the first year after AA and showed a sig-nificant association between pARC score and poor outcome (lack of antibiotic efficacy or recurrence of appendicitis) (p: 0.04). Of note, children with pARC score <75 points had a 93% chance of having a favorable response to AT. Moreover, at the first follow-up 1 month after the AA episode, the thickening of perivisceral fat found on ultrasound examination was directly related to the long-term recurrence of appendicitis (p<0.05).Conclusions. The main result of our study is the high efficacy rate of AT in children with uncomplicated AA, which is com-parable to appendicectomy efficacy rate. However, children treated with AT showed a non-negligible AA relapse rate in the first year of follow-up, which resulted in the need for surgical treatment. The pARC score may help identifying children who will more likely benefit from a non-operative intervention.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
