Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial

Area of Science:

• Medicine
• Surgery
• Infectious Diseases

Background:

• Appendectomy is the standard treatment for acute appendicitis.
• Previous studies on antibiotic treatment for appendicitis were small and uncontrolled.
• This study introduces the first multicenter randomized trial comparing appendectomy with antibiotic therapy.

Purpose of the Study:

• To compare the efficacy and safety of antibiotic therapy versus appendectomy for acute appendicitis in male patients.
• To evaluate the short-term and long-term outcomes of both treatment modalities.

Main Methods:

• A multicenter randomized trial involving 252 male patients aged 18-50.
• Patients were randomized to either immediate appendectomy (open or laparoscopic) or intravenous/oral antibiotic therapy.
• Patients receiving antibiotics were monitored for symptom resolution, with surgery reserved for non-responders within 24 hours.

Main Results:

• 86% of patients treated with antibiotics improved without surgery.
• The surgery group had a 14% complication rate.
• The antibiotic group experienced a 14% recurrence rate of appendicitis symptoms over 1 year, with 5% developing a perforated appendix.

Conclusions:

• Antibiotic therapy is a viable treatment option for acute non-perforated appendicitis in men.
• The risk of recurrence with antibiotic treatment must be weighed against the complication risks associated with appendectomy.