Pediatrics · Medical Literature
Comparison of Two Antibiotic Combinations for Conservative Treatment of Non-Complicated Appendicitis in Children.
Abstract
Background and Objectives: Acute appendicitis is the most common surgical emergency in children. The standard of care has been appendectomy for many years. However, in recent years, studies investigating antibiotic therapy alone have increased rapidly, suggesting that non-operative management may be an effective alternative with a lower risk of complications. In this study, we compared two antibiotic regimens (ceftazidime/metronidazole and ampicillin/metronidazole) to evaluate the effectiveness of two antibacterial strategies. Materials and Methods: A total of 41 children aged 7-18 years were enrolled and randomly assigned to one of the two treatment groups, with the follow-up conducted over one year to assess recurrence. For the evaluation of antibiotic effectiveness, inflammation was assessed using leukocyte count, C-reactive protein, and the biomarkers IL-6, IL-8, and MCP-1, which were measured on each of the three days of inpatient antibiotic therapy. Results: Analysis of the collected data revealed no statistically significant difference in inflammatory markers between the two treatment groups. Conclusions: These findings suggest that both antibiotic regimens offer comparable clinical outcomes and may be used interchangeably in clinical practice.
Clinical relevance
Acute appendicitis is the most common pediatric surgical emergency, and while appendectomy has historically been the standard of care, non-operative management with antibiotics is an emerging alternative. This study directly addresses the clinical gap of optimal antibiotic regimen selection for conservative management of uncomplicated appendicitis in children aged 7–18 years. As antibiotic-first strategies gain traction in pediatric practice, head-to-head regimen comparisons are essential to guide evidence-based protocol development.
Key findings
1. A total of 41 children aged 7–18 years with non-complicated acute appendicitis were randomized to either ceftazidime/metronidazole or ampicillin/metronidazole, with 1-year follow-up for recurrence assessment. 2. No statistically significant difference was identified between the two antibiotic regimens across any of the inflammatory biomarkers measured (leukocyte count, CRP, IL-6, IL-8, and MCP-1). 3. Inflammatory markers were serially measured on each of the three days of inpatient antibiotic therapy, providing a longitudinal assessment of treatment response rather than a single time-point comparison. 4. Both regimens demonstrated comparable clinical outcomes, suggesting therapeutic equivalence between a third-generation cephalosporin-based (ceftazidime/metronidazole) and a penicillin-based (ampicillin/metronidazole) combination. 5. No specific effect sizes, confidence intervals, p-values, or NNT/NNH were reported in the abstract; quantitative statistical parameters are unavailable from the provided data. 6. Recurrence was monitored over a one-year follow-up period, though recurrence rates per group were not reported in the abstract.
Practice implications
In children aged 7–18 years with non-complicated acute appendicitis selected for non-operative management, either ceftazidime/metronidazole or ampicillin/metronidazole may be used interchangeably based on local antimicrobial stewardship protocols, allergy profiles, and institutional drug availability. Clinicians should monitor serial inflammatory markers — including leukocyte count, CRP, IL-6, IL-8, and MCP-1 — across the 3-day inpatient course to objectively assess treatment response and guide the decision to escalate to surgical intervention. Given the small sample size (n=41) and the absence of reported effect sizes or recurrence rates per group in the abstract, these findings should be considered hypothesis-generating and require validation in larger, adequately powered randomized controlled trials before broad protocol adoption.