September 2026. Volume 22. Number 3

Appendectomy is superior to antibiotic-only treatment for uncomplicated acute appendicitis in children

 
 
 
 
 
 
 
 
 
 
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AVC | Critically appraised articles

Lu K, Shu S, Wang J, Mao W, Zhang F, Cheng Y et al. Can Antibiotic Therapy Replace Surgery in Pediatric Acute Uncomplicated Appendicitis? An Updated Meta‑Analysis of Randomized Controlled Trials. J Pediatr Surg. 2025; 60:162565.

Reviewers: Esteban Ibarra M1, Cuestas Montañés EJ2.
1Servicio de Pediatría. Hospital Británico de Buenos Aires. Argentina.
2Servicio de Pediatría y Neonatología. Hospital Privado Universitario de Córdoba. Córdoba. Argentina.
Correspondence: Mariano Esteban Ibarra. Email: marianoestebanibarra@gmail.com
Reception date: 11/06/2026
Acceptance date: 25/06/2026
Publication date: 08/07/2026

Abstract

Authors´ conclusions: in children aged 0 to 18 years with uncomplicated acute appendicitis nonoperative management (NOM) management with antibiotics is associated with significantly higher rates of initial, one-year after discharge, and overall treatment failure compared with appendectomy. Non-surgical management was associated with a higher frequency of adverse events, longer hospital stays, and a higher rate of rehospitalization. Surgery remains the primary treatment strategy, while NOM could be considered for select cases with careful risk-benefit evaluation.

Reviewers´ commentary: the study demonstrates the superiority of appendectomy over antibiotic therapy alone for uncomplicated appendicitis in children aged 0 to 18 years. The diversity of the antibiotic treatments included and the small number of included trials limit the generalizability of the results. Appendectomy should remain the treatment of first choice in pediatric patients.

How to cite this article

Esteban Ibarra M, Cuestas Montañés E. La apendicectomía es superior al tratamiento antibiótico exclusivo en la apendicitis aguda no complicada en niños. Evid Pediatr. 2026;22:25.

AVC | Critically appraised articles

Lu K, Shu S, Wang J, Mao W, Zhang F, Cheng Y et al. Can Antibiotic Therapy Replace Surgery in Pediatric Acute Uncomplicated Appendicitis? An Updated Meta‑Analysis of Randomized Controlled Trials. J Pediatr Surg. 2025; 60:162565.

Reviewers: Esteban Ibarra M1, Cuestas Montañés EJ2.
1Servicio de Pediatría. Hospital Británico de Buenos Aires. Argentina.
2Servicio de Pediatría y Neonatología. Hospital Privado Universitario de Córdoba. Córdoba. Argentina.
Correspondence: Mariano Esteban Ibarra. Email: marianoestebanibarra@gmail.com
Reception date: 11/06/2026
Acceptance date: 25/06/2026
Publication date: 08/07/2026

How to cite this article

Esteban Ibarra M, Cuestas Montañés E. La apendicectomía es superior al tratamiento antibiótico exclusivo en la apendicitis aguda no complicada en niños. Evid Pediatr. 2026;22:25.

08/07/2026

Linked Comment

Methodological note