Acute appendicitis in pediatric age: medical versus surgical therapy

Background: Recent studies on adults have analyzed the efficacy of antibiotic therapy as first-line non-operative intervention for acute appendicitis (AA). To date, scientific evidence in children is scarce. We evaluated the efficacy of a broad-spectrum antibiotic therapy compared to appendectomy in children with uncomplicated AA. Methods: Children with uncomplicated AA were stratified according to clinical, biochemical and ultrasonographic parameters and then randomized to receive surgical or medical treatment. Shortand long-term outcomes were recorded. Results: We enrolled 126 children (61 boys, 65 girls; mean age ± SD: 115,6 ± 32,1 months). According to the randomization protocol, 52 children received antibiotic therapy and 74 underwent appendectomy. Antibiotic therapy was effective in 49/52 (94.2%) children. Children treated with antibiotic therapy presented an overall recurrence rate of 12.2% during the first year after AA. Children with pARC score < 75 points had a 93% chance of having a favorable prolonged response to antibiotic therapy. Perivisceral fat thickening on ultrasound performed 1 month after AA was directly related to the long-term recurrence of appendicitis (p < 0.01). Conclusions: The main result of our study is the high efficacy rate of antibiotic therapy in children with uncomplicated AA, which is comparable to appendicectomy efficacy rate. Nevertheless, children treated with antibiotic therapy 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 can help identify children who are most likely to benefit from non-surgical treatment.