- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01356641
Antibiotic Treatment Alone for Acute Simple Appendicitis in Children
Antibiotic Treatment Alone for Acute Simple Appendicitis in Children; a Prospective Cohort Study Part of the Antibiotic Versus Primary Appendectomy in Children (APAC) Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Primary Objective:
What is the complication rate of the initial antibiotic treatment strategy (IATS) for acute simple appendicitis (radiological proven) in children aged 7-17 years old?
Secondary Objective:
What is the complication rate of the direct appendectomy treatment strategy (DATS) for acute simple appendicitis (radiological proven) in children aged 7-17 years old?
Study design:
Prospective multi-centre pilot cohort study.
Study population:
Children (7-17years old) with radiologically proven simple appendicitis.
Intervention:
Initial antibiotic treatment strategy (IATS): Intravenous administration of amoxicillin/clavulanic acid 25/2.5mg 6-hourly (total 100/10 mg/kg daily; maximum 6000/600mg a day) and gentamicin 7mg/kg once daily will be given for 48 hours. If possible the antibiotics will be switched to oral amoxicillin/clavulanic acid 50/12.5 mg/kg 8-hourly (max 1500/375mg a day) for in total 7 days. If after 72 hours, the patient does not meet the predefined criteria, an appendectomy will be performed.
Control group:
The control group will consist of patients, who do not want the antibiotic treatment. Their medical files will be monitored prospectively. In addition they will be scheduled for an extra outpatient clinic follow up (8 weeks after discharge), extra telephone contact one year after discharge and asked to fill out quality of life questionnaires.
Primary parameters/endpoints:
Safety of initial antibiotic treatment defined as:
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 parameters Major complications associated with appendectomy
- Stumpleakage
- Intra-abdominal abscess (IAA)
- Secondary bowel obstruction (SBO)
- Superficial site infection (SSI)
- Need for secondary operation
- Need for other re-intervention
- Re-admission
- Anaesthesia related complication
- Pneumonia
Nature and extent of the burden and risks associated with participation, benefit and group relatedness:
- Risks of participation: Need for delayed operation, recurrent appendicitis. Risks that are also present in case of non-participation: Allergic reaction to antibiotics, known appendectomy associated complications.
- Burden of participation: Extra admission day (in comparison with appendectomy), ultrasonography after 48 hours (extra procedure), outpatient follow up (two extra visits), filling out QOL questionnaires. Burden also present in case of non-participation: Intravenous access (normal procedure), daily blood samples (normal procedure). Regarding the control group, the burden will consist of an extra outpatient clinic follow up (8 weeks after discharge), extra telephone contact one year after discharge and fill out quality of life questionnaires.
- Benefit of participation: Avoidance of surgery and its related early and late morbidity, potential better quality of life.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Almere, Netherlands
- Flevoziekenhuis
-
Amsterdam, Netherlands
- VU University Medical Center
-
Amsterdam, Netherlands
- Academic Medical Center of Amsterdam
-
Beverwijk, Netherlands
- Red Cross Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age 7-17 years
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:
Patients with severe general illness at time of presentation:
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
- Severe sepsis or septic shock, as defined by the international paediatric sepsis consensus conference [39]. See attachment 1.
- Signs of complex appendicitis
- Children with a fecalith on ultrasonography.
Patients with serious associated conditions or malformations such as:
- Congenital or acquired cardiac or pulmonary disease with significant hemodynamic consequences
- Immunodeficiency
- Malignancy
- Homozygous sickle cell disease
- Metabolic disorders
- Patient with documented type 1 allergy to the antibiotics used
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
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) |
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
|
Appendectomy either open or laparoscopic depending on the surgeon's preference
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Safety of initial antibiotic treatment strategy
Time Frame: 0-12 months
|
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 |
0-12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Safety of the direct appendectomy treatment strategy
Time Frame: 0-12 months
|
Major complications associated with appendectomy
|
0-12 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Ramon R Gorter, MD, Amsterdam UMC, location VUmc
- Study Chair: Hugo A Heij, MD, PhD, Amsterdam UMC, location VUmc
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- KCA2011/APAC
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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