Antibiotics are less effective than surgery for appendicitis, finds new study
Summary:
An international trial compared two interventions for appendicitis in children to help guide future treatment guidelines.
The prestigious medical journal, The Lancet, has just published the first large-scale, randomized controlled trial to compare two treatment options in children with appendicitis: antibiotics versus surgery (appendectomy). The trial found that intravenous antibiotics provide significantly worse outcomes compared to surgery for children with non-perforated appendicitis.
At The Hospital for Sick Children (SickKids), Dr. Agostino Pierro, senior author on the publication, Senior Associate Scientist in the Translational Medicine program and Paediatric Surgeon in the Division of General and Thoracic Surgery, designed the trial and established an international collaborative network of experts spanning 14 centres to support the trial’s success.
Known as the APPY trial, the study ran for six years and evaluated 936 children aged five to 16 years from 11 hospitals, including Children’s Mercy in Kansas City which coordinated the study, as well as other hospitals across Canada, the US, Finland, Sweden and Singapore. Participants were randomly assigned to two groups: one group received antibiotics, while the other group underwent surgery.
“The outcomes of this trial offer vital evidence to guide future treatment guidelines for appendicitis,” says Pierro, who is also a Professor of Surgery at the University of Toronto. “Our findings fill an important knowledge gap that will provide evidence-based talking points for discussions on treatment options with patients and families.”
Results at the 12-month follow-up showed that 34 per cent of the children in the antibiotic group experienced treatment failure (meaning the appendix had to be later removed due to a recurrence of appendicitis), compared to just seven per cent failure in the surgery group (meaning the removed appendix was found to be healthy).
While there were no deaths or serious adverse events in either group, children in the antibiotic group had a higher risk of mild-to-moderate adverse events and stayed in the hospital longer compared to those who had surgery, despite having an early return to school and normal activities.
Pierro and his team will continue investigating the most effective treatment strategies for paediatric appendicitis.
“International collaboration and knowledge sharing is essential to improving care for all children,” he notes. “I am proud to be part of a global team dedicated to evidence-based care.”