Appendicitis: Antibiotics versus appendicectomy as primary acute treatment
DISEASE INTERVENTION COMPARISON RESULTS
JAMA. 2018 09 25;320(12):1259-1265 Randomized Controlled Trial, Multicenter Study
IN pain, abdominal, acute, appendicitis, uncomplicated, adults The Use of
antibiotics: ertapenem IV (1 g/d) for 3 days followed by 7 days of levofloxacin PO (500 mg once daily) and metronidazole PO (500 mg 3 times per day)
As Treatment, Acute
Is better Than
appendectomy
To reduce at 5 years the overall complications rate (7% antibiotics VS 24% appendectomy), despite a cumulative incidence of appendicitis recurrence of 39% in the antibiotics group
Br J Surg. 2009 May;96(5):473-81 Randomized Controlled Trial, Multicenter Study
IN pain, abdominal, acute, appendicitis, adults The Use of
antibiotics: cefotaxime and metronidazole IV first, then ciprofloxacine and metronidazole PO
As Treatment, Acute
Is better Than
appendicectomy, open or laparoscopy
To reduce major complications: 5.4% antibiotics VS 10.8% surgery by intention to treat, 2% antibiotics VS 10% surgery per protocol. 7% of patients on antibiotics need acute surgery, and 9% had recurrence at 1 year.
Br J Surg. 1995 Feb;82(2):166-9 Randomized Controlled Trial
IN pain, abdominal, acute, appendicitis, adults The Use of
antibiotics: IV for 2 days, then PO for 10 days
As Treatment, Acute
Is better Than
appendicectomy, open or laparoscopy
To avoid surgery and complications: 1 of 20 patients on antibiotics needed acute surgery, 7 patients recurred appendicitis at 1 year.
JAMA Pediatr. 2017 May 01;171(5):426-434 Meta-Analysis
IN pain, abdominal, acute, appendicitis, children The Use of
antibiotic treatment
As Treatment, Acute
Is equal Than
appendectomy
To obtain clinical success (91% on antibiotics). But appendicitis with appendicolith had a high failure rate: probably surgery better in this case
World J Surg. 2006 Jun;30(6):1033-7 Randomized Controlled Trial
IN pain, abdominal, acute, appendicitis, non perforated, adults The Use of
antibiotics: IV for 2 days, then PO for 10 days
As Treatment, Acute
Is better Than
appendicectomy, open or laparoscopy
To reduce surgery and complications: 14% of patients on antibiotics needed acute surgery, 14% more patients had appendicitis recurrence at 1 year.