BACKGROUND: Appendectomy is considered the gold standard treatment for acute appendicitis. Recently the need for surgery has been challenged in both adults and children. In children there is growing clinician, patient and parental interest in non-operative treatment of acute appendicitis with antibiotics as opposed to surgery. To date no multicentre randomised controlled trials that are appropriately powered to determine efficacy of non-operative treatment (antibiotics) for acute appendicitis in children compared with surgery (appendectomy) have been performed.

METHODS: Multicentre, international, randomised controlled trial with a non-inferiority design. Children (age 5–16 years) with a clinical and/or radiological diagnosis of acute uncomplicated appendicitis will be randomised (1:1 ratio) to receive either laparoscopic appendectomy or treatment with intravenous (minimum 12 hours) followed by oral antibiotics (total course 10 days). Allocation to groups will be stratified by gender, duration of symptoms (> or <48 hours) and centre. Children in both treatment groups will follow a standardised treatment pathway. Primary outcome is treatment failure defined as additional intervention related to appendicitis requiring general anaesthesia within 1 year of randomisation (including recurrent appendicitis) or negative appendectomy. Important secondary outcomes will be reported and a cost-effectiveness analysis will be performed. The primary outcome will be analysed on a non-inferiority basis using a 20% non-inferiority margin. Planned sample size is 978 children.

DISCUSSION: The APPY trial will be the first multicentre randomised trial comparing non-operative treatment with appendectomy for acute uncomplicated appendicitis in children. The results of this trial have the potential to revolutionise the treatment of this common gastrointestinal emergency. The randomised design will limit the effect of bias on outcomes seen in other studies.

Appendectomy versus non-operative treatment for acute uncomplicated appendicitis in children: study protocol for a multicentre, open-label, non-inferiority, randomized controlled trial


BACKGROUND: Drug-related problems (DRPs) and errors occur frequently in general health and pediatric care due to several reasons.


AIM: This study aims to determine the DRPs incidence in pediatric inpatients utilizing antibiotics in Universitas Sumatera Utara Hospital, Medan, Indonesia.


MATERIALS AND METHODS: It was carried out in May–July 2019 using a retrospective cross-sectional method and the data obtained from June to December 2018.


RESULTS: In the aforementioned hospital, the medical records of patients were 575 among which 135 (23.47%) met the inclusion criteria and the males, 84 (62.22%) were higher than females. Furthermore, majority of them, 55 (40.74%) were 5–11 years old, and 86 (63.70%) had a maximum stay length of ≥5 days. There were 73 DRPs events in 37 patients, namely, 46 (63.01%) low doses, 22 (30.14%) overdoses, 2 (2.74%) side effects of drugs, and 3 (4.11%) drug interactions. The most experienced antibiotic DRPs were in cefotaxime 14 (19.17%) and the most diagnosed was in appendicitis 14 (10.37%) utilization.

CONCLUSION: There were antibiotic DRPs in pediatric inpatients in Universitas Sumatera Utara Hospital, Medan.

/pdf/the-study-of-drug-related-problems-in-pediatric-inpatients-3uhqzsq8.pdf

The Study of Drug-Related Problems in Pediatric Inpatients Utilizing Antibiotics in Universitas Sumatera Utara Hospital Medan, Indonesia

Appendicitis is a surgical emergency, characterized classically by right lower quadrant pain, vomiting, and fever, due to an inflamed vermiform appendix. The lifetime risk of developing acute appendicitis is approximately 9%, with children aged 10–14 years being most commonly affected. The exact etiology of this condition is incompletely understood. Appendicitis may be complicated by perforation or formation of an intra-abdominal abscess or inflammatory mass. Diagnosis is primarily dependent on clinical parameters with radiological investigations such as ultrasound and computed tomography being of value in those with inconclusive clinical findings. A high index of suspicion is required in preschool children who commonly present with atypical features and more advanced appendicitis. Laboratory investigations lack sensitivity or specificity for diagnosis. Following diagnosis, expedient surgery following fluid resuscitation and broad-spectrum antibiotic therapy is appropriate in most cases. In those with an appendix mass, initial non-operative treatment with antibiotics followed by interval appendectomy may be the best approach. Laparoscopic appendectomy has several advantages over open appendectomy regarding postoperative pain control, ileus, return to diet, and duration of hospital stay. It is thus becoming a more frequently used operative modality for appendicitis. Surgical site infections and intestinal obstruction are the most commonly encountered complications. Postoperative antibiotics reduce the incidence of surgical site infection, especially in complicated appendicitis. While the principles of diagnosis and treatment of appendicitis have changed little in the last century, developments in laparoscopic technology, like single-port appendectomy, and changing evidence regarding non-operative treatment of uncomplicated appendicitis may improve patient outcomes in the future.

Appendicitis (General Pediatric Surgery of Abdomen)

Hemangiomas and Other Vascular Anomalies

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Appendicitis (General Pediatric Surgery of Abdomen)

Hemangiomas and Other Vascular Anomalies