Table 1 Main features of the included RCTS

Sajjad [4]

RCT, single center, 180 patients

All children between 5 and15 years of age of both genders admitted in the pediatric surgery emergency and having pediatric appendicitis score (PAS ≥ 7)

Primary outcome: Failure of NOM

PAS greater than or equal to 7

Perez Otereo [22]

RCT, single center, 39 patients

Patients between the ages of 6–17 years presenting with their first episode of uncomplicated acute appendicitis. Inclusion criteria for uncomplicated appendicitis consisted of < 48 h of symptoms, WBC < l8,000 µL, temperature < 103• Fahrenheit, appendix diameter < 11 mm, and radiographic absence of perforation or abscess on ultrasound and/or computed tomography (CT). Presence of an appendicolith did not exclude patients from eligibility

Primary outcomes: one–year success rate of antibiotics-alone and QOL measures assessed 1 month post discharge. Secondary outcome: length of stay and readmission rate

Abdominal US in 31 patients, while 5 patients were diagnosed solely by CT scan, and 3 were evaluated by both Imaging modalities when ultrasound was inconclusive

Svensson [21]

RCT, single center, 50 patients

All children between 5 and15 years of age of both genders admitted in the pediatric surgery emergency

Primary outcome: proportion of children in each group achieving •resolution of symptoms without significant complications”; Secondary outcomes: time from randomization to discharge, complications (wound infection, wound dehiscence, diarrhea, etc.), and recurrent appendicitis within 1 year of randomization

The diagnosis was made with the combination of clinical findings and imaging. All children underwent abdominal ultrasound scan, and a computed tomographic (CT) scan was performed when there was diagnostic: uncertainty

Sajjad [4]

Intravenous meropenem (10 mg/kg/dose intravenous infusion 8 hourly) and metronidazole (20 mg/kg/day intravenous divided doses 8 hourly) for at least 48 h. Once the child started tolerating oral intake and clinically improved, the treatment was changed to oral ciprofloxacin (10 mg/kg/dose twice daily) and metronidazole (20 mg/"q./day two divided doses) for another 8 days

Not specified

10.11 ± 1.83

9.56 ± 1.82

7.79 ± 1.76

7.77 ± 1.8

1 Year

Perez Otero [22]

Intravenous piperacillin/tazobactam for 24–48 h followed by 10 days of oral ciprofloxacin and metronidazole

Laparoscopic

9.7 (7.3–14.4)

10.2 (8.5–11.1)

12.5 (5.0–41)

9.6 (3.3–22)

1 Year

Svensson [21]

Days 1–2: IV meropenem (10 mg/kg × 3 per 24 h) plus metronidazole {20 mg/kg × 1 per 24 h)

Days 3–10: PO ciprofloxacin (20 mg/kg × 2 per 24 h) and metronidazole (20 mg/kg × 1 per 24 h)

Laparoscopic

11.1 (6.2–14.8)

12.2 (5.9–15.0)

27.0 (1.0–175.0)

30.5 (1.0–185.0)

1 Year