## Protocol Section
### Identification Module
**NCT ID:** NCT04755179

**Acronym:** CAPP

**Brief Title:** Identification of the Optimal Treatment Strategy for Complex Appendicitis in the Pediatric Population

**Official Title:** The Identification of the Optimal Treatment Strategy for Complex Appendicitis in the Pediatric Population

#### Organization Study ID Info
**ID:** W18_302#18.348
#### Organization
**Class:** OTHER
**Full Name:** Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
### Status Module
#### Completion Date
**Date:** 2023-07-12

**Type:** ESTIMATED

#### Expanded Access Info
#### Last Update Post Date
**Date:** 2022-07-25

**Type:** ACTUAL

**Last Update Submit Date:** 2022-07-22

**Overall Status:** RECRUITING

#### Primary Completion Date
**Date:** 2023-05-12

**Type:** ESTIMATED

#### Start Date
**Date:** 2019-08-12

**Type:** ACTUAL

**Status Verified Date:** 2022-07

#### Study First Post Date
**Date:** 2021-02-16
**Type:** ACTUAL
**Study First Submit Date:** 2021-01-29
**Study First Submit QC Date:** 2021-02-10
### Sponsor Collaborators Module

#### Collaborators

**Class:** OTHER

**Name:** ZonMw: The Netherlands Organisation for Health Research and Development

**Class:** OTHER

**Name:** Amsterdam UMC, location VUmc

#### Lead Sponsor

**Class:** OTHER

**Name:** Ramon Gorter

#### Responsible Party

**Investigator Affiliation:** Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

**Investigator Full Name:** Ramon Gorter

**Investigator Title:** Dr.

**Type:** SPONSOR_INVESTIGATOR

### Oversight Module

**Is FDA Regulated Device:** False

**Is FDA Regulated Drug:** False

**Oversight Has DMC:** False

### Description Module

**Brief Summary:** Aim of this study is to evaluate the effect of different treatment strategies on overall complications, health related-Quality of Life (hr-QOL) and costs among two subtypes of complex appendicitis in children (\<18 years old).

Main research questions: What is the difference in overall complications at three months between:

Subgroup 1 (complex appendicitis without abscess/mass formation): Laparoscopic (LA) and open appendectomy (OA) Subgroup 2: (complex appendicitis with abscess/mass formation): Non-operative treatment (NOT) and direct appendectomy

**Detailed Description:** Up till now initiated research projects worldwide mainly focus on simple appendicitis (questioning the necessity of an appendectomy). However, complex appendicitis is associated with significant morbidity (up to 30%), prolonged hospital stay and high costs. Identification of the optimal treatment strategy for children with complex appendicitis is therefore essential. Heterogeneity in the treatment of complex appendicitis still exists in daily practice and reflects the lack of high-quality data and emphasizes the need for well-designed studies. Complex appendicitis can be divided into two subtypes:

1. Complex appendicitis without mass/abscess. (subgroup 1) Although (inter)national guidelines agree that appendectomy should be usual care, the optimal approach (open or laparoscopy) is unclear. Laparoscopic appendectomy (LA) is increasingly applied both in adults (80%) and children (60%). Benefits reported for LA in children are, but not limited to, less superficial site infection (SSI), reduced length of hospital stay and significant less postoperative bowel obstruction compared with open appendectomy (OA). Reluctance for usage of LA in this specific subgroup, however, remains due to the potential higher incidence of post-appendectomy abscess formation (PAA) reported. However, the quality of studies on this topic is low and there is considerable inconsistency in results.
2. Complex appendicitis with mass/abscess. (subgroup 2) The recommendation made in our national guideline (to perform direct appendectomy in this subgroup) is not in line with the available literature. A recent Cochrane review on this topic could only include two trials and stated that no firm conclusions could be drawn. An older systematic review, including 7 studies in children, concluded that non-operative treatment (NOT) led to fewer complications, specifically SSI and PAA, when compared to direct appendectomy. Still the recommendation from our national guideline is to perform a direct appendectomy based upon good experiences in the pediatric academic centers.

In order to investigate the optimal treatment for children with complex appendicitis we will perform a nationwide, multi-center, comparative, prospective cohort study. For the purpose of this study, treatment strategies will be standardized among the participating hospitals in order to reduce heterogeneity. Prospectively derived, high quality data will be sufficient to answer the research questions regarding the optimal treatment strategy for each subtype of complex appendicitis in the pediatric population. As it is a non-randomized prospective cohort study, propensity score matching technique will be performed in order to estimate the effect of the treatments adjusted for potential confounders.

### Conditions Module

**Conditions:**

- Appendicitis

- Appendix Mass

- Appendicitis Perforated

**Keywords:**

- Complex appendicitis

- Children

- Treatment

### Design Module

#### Design Info

**Observational Model:** COHORT

**Time Perspective:** PROSPECTIVE

#### Enrollment Info

**Count:** 1308

**Type:** ESTIMATED

**Study Type:** OBSERVATIONAL

### Arms Interventions Module

#### Arm Group 1

**Description:** All children (\<18 years old) that present with a suspicion of complex appendicitis without clinical or radiological signs of abscess or mass formation. Preoperative suspicion of complex appendicitis is based upon a previously developed clinical scoring system.

**Intervention Names:**

- Procedure: Laparoscopic appendectomy

- Procedure: Open appendectomy

**Label:** Complex appendicitis without abscess or mass formation

#### Arm Group 2

**Description:** All children (\<18 years old) that present with a suspicion of complex appendicitis with clinical or radiological signs of abscess or mass formation. Preoperative suspicion of complex appendicitis is based upon a previously developed clinical scoring system.

**Intervention Names:**

- Procedure: Non-operative treatment

- Procedure: Direct appendectomy

**Label:** Complex appendicitis with abscess or mass formation

### Interventions

#### Intervention 1

**Arm Group Labels:**

- Complex appendicitis without abscess or mass formation

**Description:** Laparoscopic appendectomy is performed according to daily practice but with the following standardized key points:

1. Conventional laparoscopy (three-trocar technique)
2. In case of purulent fluid: Suction and no peritoneal lavage procedure
3. Skelletizing of the mesoappendix (coagulation/clips according to routine practice locally)
4. Appendiceal stump closure: with two endoloops and dissected between the endoloops. In case of involvement of the appendiceal base, the use of endostapler is recommended.
5. Withdrawal of appendix: principle of abdominal wall protection is followed (trocar technique / endobag)
6. No drain placement, no nasogastric tube, and no urinary catheter routinely, only on indication.
7. Closure of wounds as appropriate

**Name:** Laparoscopic appendectomy

**Type:** PROCEDURE

#### Intervention 2

**Arm Group Labels:**

- Complex appendicitis without abscess or mass formation

**Description:** Open appendectomy will be performed according to the following standardized key points:

1. Gridiron incision at the right lower quadrant. (McBurney's point)
2. After obtaining access to the abdominal cavity the principle of abdominal wall protection will be followed.
3. The appendiceal stump will be closed by ligation, not a purse string suture.
4. Closure of wounds as appropriate

**Name:** Open appendectomy

**Type:** PROCEDURE

#### Intervention 3

**Arm Group Labels:**

- Complex appendicitis with abscess or mass formation

**Description:** Non-operative treatment consisting of administration of intravenous antibiotics with or without drainage procedures (in case of an abscess), reserving an appendectomy for those not responding or with recurrent disease.

One of the two antibiotic regiments:

1. Combination A:

   1. Amoxicillin/clavulanic acid 25/2.5mg/kg 6 hourly (total 100/10 mg/kg daily. Maximum 6000/600mg a day) for children \<40 kg OR Amoxicillin/clavulanic acid 1000/200mg/kg 8 hourly (total 3000/6000 mg/kg daily) for children \> 40 kg
   2. Gentamicin 7mg/kg once daily
2. Combination B:

   1. Cefuroxim 25 mg/kg 6 hourly (total 100 mg/kg/day. Maximum 6gram/day)
   2. Metronidazole 10mg/kg 8hourly (total 30 mg/kg/day. Maximum 4000 mg/day) In case of peri-appendicular abscess the decision can be made to perform a drainage procedure either percutaneously or surgical.

**Name:** Non-operative treatment

**Type:** PROCEDURE

#### Intervention 4

**Arm Group Labels:**

- Complex appendicitis with abscess or mass formation

**Description:** laparoscopic or open appendectomy as described

**Name:** Direct appendectomy

**Type:** PROCEDURE

### Outcomes Module

#### Primary Outcomes

**Description:** The proportion of patients experiencing any complication within 3 months after inclusion

**Measure:** Overall complications

**Time Frame:** 3 months

#### Secondary Outcomes

**Description:** Proportion patients with a postappendectomy abscess

**Measure:** Postappendectomy abscess

**Time Frame:** 3 months

**Description:** Proportion of patients with a superficial site infection

**Measure:** Superficial Site Infection

**Time Frame:** 3 months

**Description:** Proportion of patients with a secondary/prolonged bowel obstruction

**Measure:** Secondary bowel obstruction

**Time Frame:** 3 months

**Description:** Number of days absent from school, social or sports events

**Measure:** Days absent from school, social or sports events

**Time Frame:** 30 days, 3 months

**Description:** Number of days that parents are absent from work

**Measure:** Number of days absent from work

**Time Frame:** 30 days, 3 months

**Description:** Total number of extra visits to the outpatient clinic, general pratctitioner's office or emergency department

**Measure:** Total number of extra visits

**Time Frame:** 30 days, 3 months

**Description:** Total length of hospital stay during follow-up due to trategy related treatment or complications

**Measure:** Length of hospital stay

**Time Frame:** 3 months

**Description:** Level of pain measured according to the Visual Analogue Scale (0-10 points, higher scores indicating worse outcomes)

**Measure:** Level of pain

**Time Frame:** at inclusion/baseline (=day 0), 3 days, 5 days, 30 days, 3 months

**Description:** Pain medication utilization during admission

**Measure:** Pain medication utilization

**Time Frame:** 30 days, 3 months

**Description:** Proportion of patients not having to undergo appendectomy within 3 months after start of non-operative treatment

**Measure:** Need for appendectomy

**Time Frame:** 3 months

**Description:** Proportion of patients experiencing recurrent appendicitis within 3 months after inclusion

**Measure:** Recurrent appendicitis

**Time Frame:** 3 months

**Description:** Proportion of patients experiencing early failure of initial non-operative treatment

**Measure:** Early failure of non-operative treatment

**Time Frame:** 3 months

**Description:** QoL measured by the validated EQ-5d-Youth / EQ-5d-Proxy questionnaire (0-1 point, higher scores indicating better outcome)

**Measure:** Quality of Life questionnaire (EQ-5d-Youth/EQ-5d-Proxy)

**Time Frame:** at inclusion/baseline (=day 0), 30 days, 3 months

**Description:** QoL measured by the validated Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) (0-100 points, higher scores indicating better outcome) Labor Questionnaire (HLQ), Medical Consumption Questionnaire (iMCQ) and Productivity Consumption Questionnaire (iPCQ) and gathered actual health care cost

**Measure:** Quality of Life questionnaire (PedsQL 4.0)

**Time Frame:** at inclusion/baseline (=day 0), 30 days, 3 months

**Description:** Medical costs measured by the iMedical Consumption Questionnaire

**Measure:** Medical costs (iMCQ)

**Time Frame:** at inclusion/baseline (=day 0), 30 days, 3 months

**Description:** Non-medical / indirect costs measured by the iProductivity Cost Questionnaire

**Measure:** Non-medical / indirect costs (iPCQ)

**Time Frame:** at inclusion/baseline (=day 0), 30 days, 3 months

**Description:** Quality adjusted life months calculated using outcomes 14 -17

**Measure:** Quality adjusted life months (QALM's)

**Time Frame:** 3 months

**Description:** Patient satisfaction measured by the Patient Satisfaction Questionnaire (PSQ) (0-100, higher scores indicating better outcome)

**Measure:** Patient satisfaction questionnaire (PSQ-18)

**Time Frame:** 3 months

**Description:** Patient satisfaction measured by the NET PROMOTOR SCORE (0-10, higher scores indicating better outcome)

**Measure:** Patient satisfaction questionnaire (Net promotor score)

**Time Frame:** 3 months

### Eligibility Module

**Eligibility Criteria:** Inclusion Criteria:

Eligible for inclusion are all children \<18 years old that need to undergo treatment for the suspicion of complex appendicitis. Suspicion of complex appendicitis is based upon the following predefined criteria:

4 or more points on our scoring system developed to predict complex appendicitis. The diagnostic accuracy of this scoring system is 91% (Range: 84-98%). This scoring system consists of five variables (clinical, biochemical and radiological,each awarded points). In case the total score is 4 or more points, the patient is likely to have complex appendicitis. Variables included in the scoring system are:

* Diffuse abdominal guarding (3 points)
* CRP level more than 38 mg/L (2 points)
* Signs on ultrasound / imaging indicative for complex appendicitis (2 points)
* More than one day abdominal pain (2 points)
* Temperature more than 37.5 degrees Celsius (1 point)

Or

High index of suspicion of complex appendicitis by the treating physician. If this is the case, the treating physician will make pre-treatment note upon what clinical, biochemical or radiological variable the high index of suspicion is based.

Exclusion Criteria:

* Adult patients (=18 years old)
* Children with a suspicion of simple appendicitis (based upon the previous mentioned scoring system and radiological features)

**Maximum Age:** 17 Years

**Minimum Age:** 0 Years

**Sampling Method:** PROBABILITY_SAMPLE

**Sex:** ALL

**Standard Ages:**

- CHILD

**Study Population:** All children that present with a preoperative suspicion of complex appendicitis. This suspicion is based on 4 points or more on the abovementioned complex appendicitis scoring system OR a high index of suspicion of complex appendicitis by the treating physician.

### Contacts Locations Module

#### Central Contacts

**Contact 1:**

**Email:** rr.gorter@amsterdamumc.nl

**Name:** Ramon Gorter, MD PhD

**Phone:** 0031-205665693

**Role:** CONTACT

**Contact 2:**

**Email:** p.vanamstel@amsterdamumc.nl

**Name:** Paul van Amstel, MD

**Phone:** 0031-205665693

**Role:** CONTACT

#### Locations

**Location 1:**

**City:** Alkmaar

**Contacts:**

***Contact 1:***

- **Name:** Taco Bijlsma, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Northwest hospital group

**Status:** RECRUITING

**Location 2:**

**City:** Almere

**Contacts:**

***Contact 1:***

- **Name:** Gwen Diepenhorst, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Flevoziekenhuis

**Status:** RECRUITING

**Location 3:**

**City:** Amersfoort

**Contacts:**

***Contact 1:***

- **Name:** Esther Consten, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Meander MC

**Status:** RECRUITING

**Location 4:**

**City:** Amstelveen

**Contacts:**

***Contact 1:***

- **Name:** Frank Garssen, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Hospital Amstelland

**Status:** RECRUITING

**Location 5:**

**City:** Amsterdam

**Contacts:**

***Contact 1:***

- **Name:** Ramon Gorter, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Amsterdam UMC - Location AMC

**Status:** RECRUITING

**Location 6:**

**City:** Amsterdam

**Contacts:**

***Contact 1:***

- **Name:** Ramon Gorter, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Amsterdam UMC - Location VUmc

**Status:** RECRUITING

**Location 7:**

**City:** Amsterdam

**Contacts:**

***Contact 1:***

- **Name:** Vanessa Leijdekkers, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** OLVG

**Status:** RECRUITING

**Location 8:**

**City:** Apeldoorn

**Contacts:**

***Contact 1:***

- **Name:** Hugo Bolhuis, MD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Gelre hospital

**Status:** RECRUITING

**Location 9:**

**City:** Arnhem

**Contacts:**

***Contact 1:***

- **Name:** Charlotte Blanken, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Rijnstate

**Status:** NOT_YET_RECRUITING

**Location 10:**

**City:** Bergen Op Zoom

**Contacts:**

***Contact 1:***

- **Name:** Floortje van Eijck, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Bravis Hospital

**Status:** RECRUITING

**Location 11:**

**City:** Beverwijk

**Contacts:**

***Contact 1:***

- **Name:** Annebeth de Vries, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Red Cross Hospital

**Status:** RECRUITING

**Location 12:**

**City:** Blaricum

**Contacts:**

***Contact 1:***

- **Name:** Nanette van Geloven, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Tergooi

**Status:** NOT_YET_RECRUITING

**Location 13:**

**City:** Breda

**Contacts:**

***Contact 1:***

- **Name:** Pieter Boele van Hensbroek, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Amphia

**Status:** RECRUITING

**Location 14:**

**City:** Capelle Aan Den IJssel

**Contacts:**

***Contact 1:***

- **Name:** Richard Groenendijk, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** IJsselland Hospital

**Status:** RECRUITING

**Location 15:**

**City:** Den Haag

**Contacts:**

***Contact 1:***

- **Name:** Gerda Zijp, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Haga/JKZ

**Status:** RECRUITING

**Location 16:**

**City:** Dordrecht

**Contacts:**

***Contact 1:***

- **Name:** Maarten Lijkwan, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Albert Schweitzer Hospital

**Status:** RECRUITING

**Location 17:**

**City:** Eindhoven

**Contacts:**

***Contact 1:***

- **Name:** Misha Luyer, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Catharina hospital

**Status:** RECRUITING

**Location 18:**

**City:** Goes

**Contacts:**

***Contact 1:***

- **Name:** Jan Jansen, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Admiraal de Ruyter Hospital

**Status:** NOT_YET_RECRUITING

**Location 19:**

**City:** Groningen

**Contacts:**

***Contact 1:***

- **Name:** Jan Hulscher, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** UMCG

**Status:** RECRUITING

**Location 20:**

**City:** Haarlem

**Contacts:**

***Contact 1:***

- **Name:** Steven Oosterling, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Spaarne Gasthuis

**Status:** RECRUITING

**Location 21:**

**City:** Heerlen

**Contacts:**

***Contact 1:***

- **Name:** Evert-Jan Boerma, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Zuyderland MC

**Status:** RECRUITING

**Location 22:**

**City:** Hoorn

**Contacts:**

***Contact 1:***

- **Name:** Louise de Widt, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Dijklander

**Status:** RECRUITING

**Location 23:**

**City:** Nieuwegein

**Contacts:**

***Contact 1:***

- **Name:** Peter Go, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Sint Antonius Hospital

**Status:** RECRUITING

**Location 24:**

**City:** Nijmegen

**Contacts:**

***Contact 1:***

- **Name:** Ivo de Blaauw, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Radboud UMC

**Status:** RECRUITING

**Location 25:**

**City:** Roermond

**Contacts:**

***Contact 1:***

- **Name:** Jeroen Leijtens, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Laurentius

**Status:** RECRUITING

**Location 26:**

**City:** Rotterdam

**Contacts:**

***Contact 1:***

- **Name:** Claudia Keyzer, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Erasmus MC

**Status:** RECRUITING

**Location 27:**

**City:** Rotterdam

**Contacts:**

***Contact 1:***

- **Name:** Marijn Poelman, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Franciscus Gasthuis & Vlietland

**Status:** NOT_YET_RECRUITING

**Location 28:**

**City:** Rotterdam

**Contacts:**

***Contact 1:***

- **Name:** Wouter Vles, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Ikazia

**Status:** RECRUITING

**Location 29:**

**City:** Rotterdam

**Contacts:**

***Contact 1:***

- **Name:** Charles van Rossem, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Maasstad Hospital

**Status:** RECRUITING

**Location 30:**

**City:** Veldhoven

**Contacts:**

***Contact 1:***

- **Name:** Mart Bender, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Maxima Medical Centre

**Status:** RECRUITING

**Location 31:**

**City:** Zaandam

**Contacts:**

***Contact 1:***

- **Name:** Frank den Boer, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Zaans Medical Centre

**Status:** NOT_YET_RECRUITING

**Location 32:**

**City:** Zwolle

**Contacts:**

***Contact 1:***

- **Name:** Vincent Nieuwenhuijs, MD PhD

- **Role:** CONTACT

**Country:** Netherlands

**Facility:** Isala

**Status:** RECRUITING

#### Overall Officials

**Official 1:**

**Affiliation:** Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

**Name:** Ramon Gorter, MD PhD

**Role:** PRINCIPAL_INVESTIGATOR

### References Module

#### References

**Citation:** van Amstel P, Bakx R, van der Lee JH, van der Weide MC, Eekelen RV, Derikx JPM, van Heurn ELW, Gorter RR; CAPP collaborative study group. Identification of the optimal treatment strategy for complex appendicitis in the paediatric population: a protocol for a multicentre prospective cohort study (CAPP study). BMJ Open. 2022 Feb 17;12(2):e054826. doi: 10.1136/bmjopen-2021-054826.

**PMID:** 35177453

## Derived Section

### Condition Browse Module - Ancestors

- ID: D000059413

- Term: Intraabdominal Infections

- ID: D000007239

- Term: Infections

- ID: D000005759

- Term: Gastroenteritis

- ID: D000005767

- Term: Gastrointestinal Diseases

- ID: D000004066

- Term: Digestive System Diseases

- ID: D000002429

- Term: Cecal Diseases

- ID: D000007410

- Term: Intestinal Diseases

### Condition Browse Module - Browse Branches

- Abbrev: BC01

- Name: Infections

- Abbrev: BC06

- Name: Digestive System Diseases

- Abbrev: All

- Name: All Conditions

- Abbrev: BC23

- Name: Symptoms and General Pathology

### Condition Browse Module - Browse Leaves

- ID: M4376

- Name: Appendicitis

- Relevance: HIGH

- As Found: Appendicitis

- ID: M10283

- Name: Infections

- Relevance: LOW

- As Found: Unknown

- ID: M6368

- Name: Communicable Diseases

- Relevance: LOW

- As Found: Unknown

- ID: M29465

- Name: Intraabdominal Infections

- Relevance: LOW

- As Found: Unknown

- ID: M8875

- Name: Gastroenteritis

- Relevance: LOW

- As Found: Unknown

- ID: M7255

- Name: Digestive System Diseases

- Relevance: LOW

- As Found: Unknown

- ID: M8883

- Name: Gastrointestinal Diseases

- Relevance: LOW

- As Found: Unknown

- ID: M5679

- Name: Cecal Diseases

- Relevance: LOW

- As Found: Unknown

- ID: M10444

- Name: Intestinal Diseases

- Relevance: LOW

- As Found: Unknown

### Condition Browse Module - Meshes

- ID: D000001064

- Term: Appendicitis

### Intervention Browse Module - Browse Branches

- Abbrev: Infe

- Name: Anti-Infective Agents

- Abbrev: All

- Name: All Drugs and Chemicals

### Intervention Browse Module - Browse Leaves

- ID: M3995

- Name: Amoxicillin

- Relevance: LOW

- As Found: Unknown

- ID: M21710

- Name: Clavulanic Acid

- Relevance: LOW

- As Found: Unknown

- ID: M4222

- Name: Anti-Bacterial Agents

- Relevance: LOW

- As Found: Unknown

- ID: M5694

- Name: Cefuroxime

- Relevance: LOW

- As Found: Unknown

- ID: M349210

- Name: Cefuroxime axetil

- Relevance: LOW

- As Found: Unknown

- ID: M4224

- Name: Antibiotics, Antitubercular

- Relevance: LOW

- As Found: Unknown

- ID: M11767

- Name: Metronidazole

- Relevance: LOW

- As Found: Unknown

- ID: M8951

- Name: Gentamicins

- Relevance: LOW

- As Found: Unknown

- ID: M6204

- Name: Clavulanic Acids

- Relevance: LOW

- As Found: Unknown

### Misc Info Module

- Version Holder: 2024-05-24
