Non-operative Treatment of Appendicitis

I was lucky enough to attend a great pediatric grand-rounds, yesterday, that discussed the non-operative management of acute appendicitis, in children. This idea seemed very interesting, to me, as it has obvious applications to healthcare providers in remote areas that may not have easy access to definitive surgical care.

The information presented discussed aggresive antibiotics for 48 hours with serial ultrasound exams every 6 hours, as an alternative to surgical appendectomy. The antibiotics currently advocated are standard “triple therapy” with ampicillin, gentamicin and metronidazole. The presenter also stressed that this antibiotic combination is falling out of favor and Mefoxin (cefoxitine) or Zosyn (piperacillin/tazobactam) or cefuroxime are being considered as better selections, by some surgeons. The switch to oral antibiotics, from IV, was also discussed and a concensus that once the patient is afebrile, oral metronidazole can be used for 7-10 days.

This raises an interesting question about treatment of appendicitis in remote locations, and involving adults. Obviously, if a surgical consult is available, it should be taken advantage of. However, for the remote generalist, this is not always possible. I just wanted to present this new information (to me) as an increasingly viable option.

A few decent references I have found on this matter are below:

http://linkinghub.elsevier.com/retrieve/pii/S0022346806006476

http://archsurg.ama-assn.org/cgi/content/abstract/140/9/897

http://www.jpedsurg.org/article/S0022-3468(07)00190-X/abstract

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1856578

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