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TIMOTHY MOTT, MD, AND CARRIE GRAY, DO

Am Fam Physician. 2025;111(1):75-76

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Author disclosure: No relevant financial relationships.

CLINICAL QUESTION

Is nonoperative antibiotic therapy a practical option compared with operative treatment for uncomplicated acute appendicitis in children?

EVIDENCE-BASED ANSWER

Nonoperative treatment with antibiotics for uncomplicated acute appendicitis in children is an option but leads to higher numbers of hospital readmissions and subsequent surgeries. (Strength of Recommendation [SOR]: A, meta-analysis of randomized controlled trials [RCTs] and cohort studies.) The nonoperative approach has a treatment failure rate of approximately 20%, with most occurring in the first 2 days. (SOR: B, RCT and large cohort study.) The presence of an appendicolith visualized with ultrasonography is strongly associated with early failure of nonoperative treatment. (SOR: B, single RCT.)

EVIDENCE SUMMARY

A 2023 systematic review and meta-analysis composed of four RCTs and 13 observational studies assessed various outcomes in children with uncomplicated acute appendicitis who were treated with appendectomy or nonoperatively with antibiotics.1 Meta-analyses were performed separately on the RCTs and cohort studies for various outcomes (Table 11). Each analysis found an increased number of hospital readmissions in the nonoperative antibiotic treatment group. Also in the nonoperative antibiotic therapy group, there was an increased need for surgery beyond index assignment, and treatment occurred more often. The cohort studies analysis showed no significant differences in abscess formation, length of hospitalization, or need for an additional course of antibiotics between the two groups.

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Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email questions@fpin.org.

Copyright © Family Physicians Inquiries Network. Used with permission.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN’s Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.

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