Ramon R Gorter1, Johanna H van der Lee2, Huibert A Cense3, C M Frank Kneepkens4, Marc H W A Wijnen5, Klaas H In 't Hof6, Martin Offringa7, Hugo A Heij8. 1. Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, Amsterdam, The Netherlands; Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands. Electronic address: rr.gorter@vumc.nl. 2. Paediatric Clinical Research Office Division Woman and Child, Academic Medical Centre, Amsterdam, The Netherlands. 3. Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands. 4. Department of Paediatric Gastroenterology, VU University Medical Centre, Amsterdam, The Netherlands. 5. Department of Paediatric Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. 6. Department of Surgery, Flevoziekenhuis, Almere, The Netherlands. 7. Child Health Evaluative Sciences (CHES), The Hospital for Sick Children, University of Toronto, Toronto, Canada. 8. Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Initial antibiotic treatment for acute appendicitis has been shown to be safe in adults; so far, not much is known about the safety and efficacy of this treatment in children. The aims of this study were to investigate the feasibility of a randomized controlled trial (RCT) evaluating initial antibiotic treatment for acute appendectomy in children with acute simple appendicitis and to evaluate the safety of this approach. METHODS: In a multicenter, prospective cohort study patients aged 7-17 years with a radiologically confirmed simple appendicitis were eligible. Intravenous antibiotics (amoxicillin/clavulanic acid 250/25 mg/kg 4 times daily; maximum 6,000/600 mg/d and gentamicin 7 mg/kg once daily) were administered for 48-72 hours. Clinical reevaluation every 6 hours, daily blood samples, and ultrasound follow-up after 48 hours was performed. In case of improvement after 48 hours, oral antibiotics were given for a total of 7 days. At any time, in case of clinical deterioration or non-improvement after 72 hours, an appendectomy could be performed. Follow-up continued until 8 weeks after discharge. Adverse events were defined as major complications of antibiotic treatment, such as allergic reactions, perforated appendicitis, and recurrent appendicitis. RESULTS: Of 44 eligible patients, 25 participated (inclusion rate, 57%; 95% CI, 42%-70%). Delayed appendectomy was performed in 2, and the other 23 were without symptoms at the 8 weeks follow-up. Minor complications occurred in three patients. None of the patients suffered from an adverse event or a recurrent appendicitis. CONCLUSION: Our study shows that an RCT comparing initial antibiotic treatment strategy with urgent appendectomy is feasible in children; the intervention seems to be safe.
BACKGROUND: Initial antibiotic treatment for acute appendicitis has been shown to be safe in adults; so far, not much is known about the safety and efficacy of this treatment in children. The aims of this study were to investigate the feasibility of a randomized controlled trial (RCT) evaluating initial antibiotic treatment for acute appendectomy in children with acute simple appendicitis and to evaluate the safety of this approach. METHODS: In a multicenter, prospective cohort study patients aged 7-17 years with a radiologically confirmed simple appendicitis were eligible. Intravenous antibiotics (amoxicillin/clavulanic acid 250/25 mg/kg 4 times daily; maximum 6,000/600 mg/d and gentamicin 7 mg/kg once daily) were administered for 48-72 hours. Clinical reevaluation every 6 hours, daily blood samples, and ultrasound follow-up after 48 hours was performed. In case of improvement after 48 hours, oral antibiotics were given for a total of 7 days. At any time, in case of clinical deterioration or non-improvement after 72 hours, an appendectomy could be performed. Follow-up continued until 8 weeks after discharge. Adverse events were defined as major complications of antibiotic treatment, such as allergic reactions, perforated appendicitis, and recurrent appendicitis. RESULTS: Of 44 eligible patients, 25 participated (inclusion rate, 57%; 95% CI, 42%-70%). Delayed appendectomy was performed in 2, and the other 23 were without symptoms at the 8 weeks follow-up. Minor complications occurred in three patients. None of the patients suffered from an adverse event or a recurrent appendicitis. CONCLUSION: Our study shows that an RCT comparing initial antibiotic treatment strategy with urgent appendectomy is feasible in children; the intervention seems to be safe.
Authors: Erica L Riedesel; Blake C Weber; Matthew W Shore; Randi S Cartmill; Daniel J Ostlie; Charles M Leys; Kara G Gill; Jonathan E Kohler Journal: Pediatr Radiol Date: 2019-07-24
Authors: Nigel J Hall; Frances C Sherratt; Simon Eaton; Isabel Reading; Erin Walker; Maria Chorozoglou; Lucy Beasant; Wendy Wood; Michael Stanton; Harriet J Corbett; Dean Rex; Natalie Hutchings; Elizabeth Dixon; Simon Grist; William Van't Hoff; Esther Crawley; Jane Blazeby; Bridget Young Journal: Health Technol Assess Date: 2021-02 Impact factor: 4.014
Authors: Max Knaapen; Johanna H van der Lee; Roel Bakx; Sarah-May L The; Ernst W E van Heurn; Hugo A Heij; Ramon R Gorter Journal: BMJ Open Date: 2017-11-15 Impact factor: 2.692