Antibiotics fall short compared with surgery for pediatric appendicitis

Antibiotic management of non-perforated appendicitis in children is inferior to appendectomy based on treatment failure rates and adverse events. These findings support the continued use of appendectomy as the preferred treatment for acute uncomplicated appendicitis in pediatric patients.

Study design: This open-label, international, multicenter, randomized, non-inferiority trial included children ages 5 to 16 years with suspected non-perforated appendicitis. Participants were recruited from 11 children's hospitals across five countries and randomly assigned to either antibiotic therapy or appendectomy. The primary outcome was treatment failure within one year, defined as the need for appendectomy in the antibiotic group or a normal appendix on pathology in the appendectomy group.

Results: A total of 936 patients were enrolled, with 459 assigned to appendectomy and 477 to antibiotics. At 12-month follow-up, treatment failure occurred in 34% of the antibiotic group compared with 7% of the appendectomy group, with a difference of 26.7% (90% confidence interval [CI], 22.4-30.9). The relative risk (RR) of mild to moderate adverse events was higher in the antibiotic group (RR, 4.3, 95% CI, 2.1-8.7). No deaths or serious adverse events were reported in either group.

Source:

St Peter SD, et al. (2025, January 18). Lancet. Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children: an open-label, international, multicentre, randomised, non-inferiority trial. https://pubmed.ncbi.nlm.nih.gov/39826968/