A role for conservative antibiotic treatment in early appendicitis in children
A role for conservative antibiotic treatment in early appendicitis in children
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DOI：
10.1016/j.jpedsurg.2015.04.008
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发表时间：
2015-09-01
影响因子：
2.4
通讯作者：
Erez, Ilan
中科院分区：
文献类型：
--
作者：
Steiner, Zvi;Buklan, Genady;Erez, Ilan
目的：评价抗生素不手术是否足以治疗临床和超声疑似急性阑尾炎（AA）的儿童。方法：前瞻性评估临床，实验室和放射学检查结果可疑AA的儿童。临床症状轻微，无腹膜炎的患者被认为是IV其次是口服抗生素，而无需surgical.Results：从2013年11月1日至2014年6月30日，45名儿童被诊断为早期急性阑尾炎。年龄范围为4至15岁（平均9.3岁），其中32人（75%）为男孩。所有患者均接受常规、临床实验室和超声检查。42例经抗生素治疗后好转，在3-5天内出院回家，无需手术。其中3例在24小时内手术，另2例因复发性阑尾炎行阑尾切除术：1例在出院后2周，另1例在出院后2个月。在6-14个月的随访中，没有再复发阑尾炎。结论：我们的一系列AA患者仅用抗生素治疗是观察的产物，一些儿童在手术仍有争议的阶段单独使用抗生素改善。这些结果（89%的成功率）支持早期阑尾炎病例的保守方法，而不会增加失败病例的发病率。(C)2015 Elsevier Inc. All rights reserved.
Purpose: To evaluate whether antibiotics without surgery is sufficient treatment for children with clinically and ultrasonographically suspected acute appendicitis (AA).Method: Children with clinical, laboratory and radiological findings suspicious for AA were evaluated prospectively. Patients with mild clinical signs, without peritonitis were considered for IV followed by oral antibiotics without surgery.Results: From1 November 2013 through 30 June 2014, 45 children were diagnosed with early, acute appendicitis. Ages ranged from 4 to 15 years (mean 9.3) and 32 (75%) were boys. All had routine, clinical laboratory and ultra-sound workup. Forty-two improved with antibiotic treatment andwere discharged home within 3-5 days, without surgery. Three of them were operated on within 24 hours, another two under went appendectomy for recurrent appendicitis: one at 2 weeks and the other 2 months after discharge. There was no more recurrent appendicitis in 6-14-month follow-up.Conclusion: Our series of patients with AA treated with antibiotics only are a product of the observation that some children improve with antibiotics alone at a stage in which surgery is still debatable. These results (89% success rate) support the conservative approach in cases of early appendicitis, without increased morbidity in failed cases. (C) 2015 Elsevier Inc. All rights reserved.