Background In patients with complicated appendicitis, interval appendectomy (IA) with a single broad-spectrum antibiotic sometimes fails. We reviewed our experience of adding metronidazole (MNZ) in such situations.

Methods Medical records of children with an appendiceal mass treated with broad-spectrum antibiotics followed by IA from March 2009 to May 2019 were reviewed. In the latter period (after April 2015, Group L, n = 14), MNZ was added if symptoms were not improved by a 3- to 4-day course of antibiotics. The body temperature, white blood cell count (WBC), serum C-reactive protein (CRP), treatment failure, and hospital stay for the initial treatment were collected in the earlier period (Group E, n = 14) and Group L.

Results There was no treatment failure. Group E tended to require a longer hospital stay (14.0 vs. 11.1 days, p = 0.099); however, the temperature, WBC, and CRP on admission were not significantly different. In the MNZ-added group (n = 8), the mean rate of change (per day) in WBC before and after the addition of MNZ were −288 ± 1,155 and −3,870 ± 1,634, respectively (p = 0.001). All patients underwent IA in about 3 months.

Conclusions This preliminary study may indicate the efficacy of MNZ combined with a broad-spectrum antibiotic followed by IA for intractable appendiceal masses.

H.S. and M.Y. designed the study. S.O., K.Ma., K.K., K.Mi., Y.M., and Y.G. manage the patients. S.O. collected the data, and S.O., H.S., and H.T. analyzed the data. S.O. wrote the draft and H.T. critically reviewed the manuscript.

Received: 06 November 2023

Accepted: 14 July 2024

Article published online:
01 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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