Antibiotic Treatment Alone for Acute Simple Appendicitis in Children

This study is currently recruiting participants. (see Contacts and Locations)
Verified February 2015 by VU University of Amsterdam
Red Cross Hospital Beverwijk
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
St. Antonius Hospital
Flevoziekenhuis, Almere
Information provided by (Responsible Party):
Ramon R. Gorter, VU University of Amsterdam Identifier:
First received: April 18, 2011
Last updated: February 3, 2015
Last verified: February 2015
Appendectomy for acute appendicitis has recently been questioned as being the only correct treatment for appendicitis. Appendectomy has been reported to have significant early and late morbidity. This can be avoided with antibiotic treatment alone. Moreover, better quality of life and lower costs have been associated with antibiotic treatment alone. Five clinical trials in selected patients (males, older than 18 years) comparing appendectomy and antibiotic treatment alone as primary mode of treatment found that antibiotic treatment alone is safe and effective in 48-95% of the patients Conclusive evidence with regard to the efficacy of antibiotic treatment alone in children with proven acute appendicitis however is lacking. We propose a prospective cohort study to answer the following questions:

Condition Intervention
Drug: Antibiotic treatment alone
Procedure: Appendectomy

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Antibiotic Treatment Alone for Acute Simple Appendicitis in Children; a Prospective Cohort Study Part of the Antibiotic Versus Primary Appendectomy in Children (APAC) Trial

Resource links provided by NLM:

Further study details as provided by VU University of Amsterdam:

Primary Outcome Measures:
  • Safety of initial antibiotic treatment strategy [ Time Frame: 0-12 months ] [ Designated as safety issue: Yes ]

    Occurrence of major complications, such as:

    A. Anaphylactic shock and other allergic reaction to antibiotics administered b. Recurrent appendicitis within 8 weeks c. Recurrent appendicitis within one year after discharge d. Development of perforated appendicitis e. Occurrence of major complaints after delayed appendectomy such as intra-abdominal abscess (IAA), stumpleakage, superficial site infection (SSI), anaesthesia related complications, secondary bowel obstruction (SBO), re-admission, need for re-intervention f. Re-admission g. Re-intervention other than delayed appendectomy

Secondary Outcome Measures:
  • Safety of the direct appendectomy treatment strategy [ Time Frame: 0-12 months ] [ Designated as safety issue: No ]

    Major complications associated with appendectomy

    1. Stumpleakage
    2. Intra-abdominal abscess (IAA)
    3. Secondary bowel obstruction (SBO)
    4. Superficial site infection (SSI)
    5. Need for secondary operation
    6. Need for other re-intervention
    7. Re-admission
    8. Anaesthesia related complication
    9. Pneumonia

Estimated Enrollment: 50
Study Start Date: September 2012
Estimated Study Completion Date: December 2016
Estimated Primary Completion Date: December 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Antibiotic treatment alone

Intravenous administration:

Amoxicillin/clavulanic acid 100/10 mg/kg 6-hourly Gentamicin 7mg/kg once daily

Oral administration of:

Amoxicillin/clavulanic acid 50/12.5 mg/kg/day (in three doses)

Drug: Antibiotic treatment alone
Amoxicillin/clavulanic acid 100/10 mg/kg 6-hourly Gentamicin 7 mg/kg once daily At least 48 hours intravenous administration, in total seven days of antibiotics Oral amoxicillin/clavulanic acid 50/12.5mg/kg
Active Comparator: Appendectomy
Routine appendectomy either laparoscopic or open depending on the surgeon's preference
Procedure: Appendectomy
Appendectomy either open or laparoscopic depending on the surgeon's preference

  Show Detailed Description


Ages Eligible for Study:   7 Years to 17 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Age 7-17 years
  2. Radiologically confirmed simple appendicitis, defined as:

    a. Clinical findings: i. Unwell, but not generally ill ii. Localized tenderness in the right iliac fossa region iii. Normal/hyperactive bowel sounds iv. No guarding v. No mass palpable b. Ultrasonography: i. Incompressible appendix with an outer diameter of ≥6 mm ii. Hyperaemia within the appendiceal wall iii. Without fecalith iv. Infiltration of surrounding fat v. No signs of perforation vi. No signs of intra abdominal abscess/phlegmon

Exclusion criteria:

  1. Patients with severe general illness at time of presentation:

    1. Generalized peritonitis defined as:

      Diffuse inflammation of the peritoneum with clinical signs consisting of increasing abdominal pain, generalized tenderness, diffuse abdominal rigidity, sinus tachycardia, signs of paralytic ileus

    2. Severe sepsis or septic shock, as defined by the international paediatric sepsis consensus conference [39]. See attachment 1.
    3. Signs of complex appendicitis
  2. Children with a fecalith on ultrasonography.
  3. Patients with serious associated conditions or malformations such as:

    1. Congenital or acquired cardiac or pulmonary disease with significant hemodynamic consequences
    2. Immunodeficiency
    3. Malignancy
    4. Homozygous sickle cell disease
    5. Metabolic disorders
  4. Patient with documented type 1 allergy to the antibiotics used
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01356641

Contact: Ramon R Gorter, MD 020-4442424
Contact: H A Heij, MD PhD 0205665693

Flevoziekenhuis Recruiting
Almere, Netherlands
Contact: K H in 't Hof, MD, PhD       kin'   
Principal Investigator: K H in 't Hof, MD, PhD         
Academic medical center of Amsterdam Recruiting
Amsterdam, Netherlands
Contact: H. A. Heij, MD, PhD    0205665693   
Principal Investigator: H A Heij, MD PhD         
VU University medical center Recruiting
Amsterdam, Netherlands
Contact: Ramon R Gorter, MD    0204442424   
Principal Investigator: Ramon R Gorter, MD         
Red Cross Hospital Recruiting
Beverwijk, Netherlands
Contact: H A Cense, MD PhD    0251265555   
Principal Investigator: H A Cense, MD PhD         
Sponsors and Collaborators
Ramon R. Gorter
Red Cross Hospital Beverwijk
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
St. Antonius Hospital
Flevoziekenhuis, Almere
Principal Investigator: Ramon R Gorter, MD VU University Medical Center
Study Chair: Hugo A Heij, MD, PhD VU University Medical Center
  More Information

No publications provided

Responsible Party: Ramon R. Gorter, MD, PhD candidate, VU University of Amsterdam Identifier: NCT01356641     History of Changes
Other Study ID Numbers: KCA2011/APAC
Study First Received: April 18, 2011
Last Updated: February 3, 2015
Health Authority: Netherlands: Medical Ethics Review Committee (METC)
Netherlands: The Central Committee on Research Involving Human Subjects (CCMO)

Keywords provided by VU University of Amsterdam:
Antibiotic treatment
Non perforated appendicitis

Additional relevant MeSH terms:
Acute Disease
Cecal Diseases
Digestive System Diseases
Disease Attributes
Gastrointestinal Diseases
Intestinal Diseases
Intraabdominal Infections
Pathologic Processes
Anti-Bacterial Agents
Antibiotics, Antitubercular
Clavulanic Acid
Clavulanic Acids
Anti-Infective Agents
Antitubercular Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Therapeutic Uses processed this record on November 27, 2015