Nonoperative treatment of acute appendicitis in children: A feasibility study

J Pediatr Surg. 2016 Jan;51(1):111-6. doi: 10.1016/j.jpedsurg.2015.10.024. Epub 2015 Oct 23.


Purpose: Nonoperative treatment of acute appendicitis appears to be feasible in adults. It is unclear whether the same is true for children.

Methods: Children 5-18 years with <48 h symptoms of acute appendicitis were offered nonoperative treatment: 2 doses of piperacillin IV, then ampicillin/clavulanate ×1 week. Treatment failure (worsening on therapy) and recurrence (after completion of therapy) were noted. Patients who declined enrollment were asked to participate as controls. Cost-utility analysis was performed using Pediatric Quality of Life Scale (PedsQL®) to calculate quality-adjusted life month (QALM) for study and control patients.

Results: Twenty-four patients agreed to undergo nonoperative management, and 50 acted as controls. At a mean follow-up of 14 months, three of the 24 failed on therapy, and 2/21 returned with recurrent appendicitis at 43 and 52 days, respectively. Two patients elected to undergo an interval appendectomy despite absence of symptoms. Appendectomy-free rate at one year was therefore 71% (C.I. 50-87%). No patient developed perforation or other complications. Cost-utility analysis shows a 0.007-0.03 QALM increase and a $1359 savings from $4130 to $2771 per nonoperatively treated patient.

Conclusion: Despite occasional late recurrences, antibiotic-only treatment of early appendicitis in children is feasible, safe, cost-effective and is experienced more favorably by patients and parents.

Keywords: Antibiotics; Appendectomy; Appendicitis; Cost-utility analysis; Nonoperative treatment.

MeSH terms

  • Acute Disease
  • Adolescent
  • Amoxicillin-Potassium Clavulanate Combination / therapeutic use*
  • Anti-Bacterial Agents / therapeutic use*
  • Appendectomy / economics
  • Appendicitis / drug therapy*
  • Appendicitis / surgery
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Drug Therapy, Combination
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Penicillanic Acid / analogs & derivatives*
  • Penicillanic Acid / therapeutic use
  • Piperacillin / therapeutic use
  • Piperacillin, Tazobactam Drug Combination
  • Quality of Life
  • Recurrence
  • Treatment Failure
  • beta-Lactamase Inhibitors / therapeutic use


  • Anti-Bacterial Agents
  • beta-Lactamase Inhibitors
  • Piperacillin, Tazobactam Drug Combination
  • Amoxicillin-Potassium Clavulanate Combination
  • Penicillanic Acid
  • Piperacillin