Antibacterial therapy for non-complicated appendicitis in children: problem of choice

Recent decade showed increased use of non-operative antibacterial treatment (NOT) for pediatric acute non-complicated appendicitis (NAA). Multiple randomized controlled trials(RCT) comparing operative treatment (OT) and NOT approach show possible feasibility of non-surgical approach in NAA. Preliminary literature review showed numerous different antibiotic drug combinations used for NAA treatment. Thus a problem of choice was raised - which antibiotic drug combination to choose? A concise literature review was performed.  A list of antibiotic drugs and their combinations used for treatment of NAA in children was formed.  Lack of RCTs regarding NOT of pediatric NAA was discovered. Two meta-analysis by Xu et al. and Georgiou et al. allowed to form a list of 18 different antibiotic drugs used for NOT of pediatric NAA. Initial treatment success varied form 58% to 100% with subsequent appendectomy varying from 4.2% to 27% of cases.  Children Clinical University Hospital in Riga uses i/v apmicillin/metronidazole combination for NOT and reports 13.5% recurrance rate of acute appendicitis. RCTs comparing different choice of antibacterial therapy for pediatric NAA are lacking. Several systematic analysis and meta-analysis studies showed necessity for further prospective randomized studies regarding NOT treatment of AA.Authors have the proposition to perform an RCT to compare clinical safety, efficacy and  cost-efficiency  of 72h  i/v ampicillin and metronidozole combination following 7 days of p/o amoxiclav -  the existent standart of care method for treating non-complicated appendicitis with a prospected 72h i/v ceftazidime and metronidazole following 7 days of p/o amoxiclav. Study is expected to show additiona insight in feasibility of NOT of NAA for pediatric population