Initial Antibiotics and Delayed Appendectomy for Acute Appendicitis
Initial Antibiotics and Delayed Appendectomy for Acute Appendicitis
Several recent studies have examined the feasibility and benefits of nonoperative treatment
 of perforated appendicitis in children. One such study showed a trend toward longer operative
 times for patients randomized to immediate appendectomy, but no overall advantage. In another
 larger study, the costs of delayed appendectomy for perforated appendicitis were higher - in
 part related to readmissions in the interval (6-8 weeks). Nevertheless, these and other
 studies have demonstrated the safety of delaying appendectomy for perforated appendicitis.

 Emergency appendectomy is a well-established approach, and postoperative recovery in children
 is fast. Nevertheless, from the onset of symptoms through the hospital stay and the
 postoperative recovery, appendicitis causes a disruption of a family's normal routine
 (absence from school and work) of up to 1-2 weeks. Because this is an unplanned operation,
 patients have to wait until an operating room becomes available, or elective operations have
 to be placed on hold to accommodate the emergency operation. Each year, more than 250
 children undergo an appendectomy at HCH. This represents 250 episodes of emergency surgery,
 or about one emergency add-on operation per working day. If an initial trial of antibiotics
 is safe for the treatment of appendicitis, converting an emergency operation into an
 elective, scheduled outpatient procedure may reduce stress and disruption of routine for
 patients and their families - and may allow better operating room planning for health care
 professionals and hospitals.

 The investigators hypothesize that initial antibiotic treatment of acute (non-perforated)
 appendicitis, followed by scheduled outpatient appendectomy, reduces the overall cost of
 treating the disease and results in greater patient and family satisfaction.

 This pilot study aims to establish the safety and feasibility of treating acute appendicitis
 with intravenous antibiotics, followed by outpatient oral antibiotics. Patients and their
 families will be offered the possibility of initial nonoperative treatment and subsequent
 outpatient elective appendectomy in a nonrandomized, single arm study.
Inclusion Criteria:

 -  Maximum 48-hour-history of abdominal pain

 -  Diagnosis of acute appendicitis based on clinical, laboratory and/or radiologic
 criteria

 Exclusion Criteria:

 -  Duration of symptoms > 48 hours

 -  Presence of an appendiceal abscess on imaging

 -  Clinical or laboratory suspicion of advanced appendicitis, peritonitis or perforation

 -  Significant comorbidities

 -  Inability or unwillingness to complete a 1-week course of oral antibiotics

 -  Allergy to penicillin