Zhang Y, et al. - Researchers investigated the therapeutic efficacy and cost-effectiveness of antibiotics alone vs antibiotics plus percutaneous drainage (PD) for management of periappendiceal abscess in a pediatric population. Performing a 10-year retrospective chart review of pediatric patients less than 18 years of age who had acute perforated appendicitis complicated by periappendiceal abscess, patients were grouped as follows: group 1 comprised patients (N = 35) who received nonoperative management with antibiotics only; group 2 comprised of patients (N = 11) who underwent PD and also received antibiotics. Subdivisions of group 1: groups 1A consisted of patients (N = 25) who responded to antibiotics treatment; Group 1B consisted of patients (N = 10) who were initially treated with antibiotics but subsequently required PD. Group 1A and group 2 had an identical median hospital stay at 6 days. A significantly longer median hospital stay of 13 days was reported for group 1B. Findings support the possible efficacy of antibiotic therapy alone in a majority of patients and emphasize it as initial management. In case clinical symptoms persist or the abscess remains unchanged, they advise not delaying PD to prevent potential complications and increased cost. Performing reimaging 6 days after initiation of antibiotic therapy with ultrasound or MRI, identification of patients who would progress on antibiotics alone or who need to receive drainage without delay is recommended.