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Appendectomy versus antibiotic treatment for acute appendicitis.
Ingrid M H A Wilms1, Dominique E N M de Hoog, Dianne C de Visser
1Department of Emergency Medicine,VieCuri Medical Centre of Northern Limburg, Venlo, Netherlands.
The Cochrane Database of Systematic Reviews
|November 11, 2011
Summary
Appendectomy remains the standard treatment for acute appendicitis. While antibiotic treatment shows promise, current evidence is inconclusive due to low-quality studies, necessitating further research.
Area of Science:
- General Surgery
- Gastroenterology
- Infectious Diseases
Background:
- Acute appendicitis is a common cause of acute abdominal pain.
- Appendectomy is the standard treatment, but carries inherent surgical risks.
- Conservative antibiotic treatment has been explored as an alternative.
Purpose of the Study:
- To compare the efficacy of antibiotic treatment versus appendectomy for acute appendicitis.
- To assess recovery within two weeks and absence of major complications within one year.
- To determine if antibiotic treatment is non-inferior to appendectomy.
Main Methods:
- Systematic review of randomized and quasi-randomized clinical trials.
- Searched multiple databases including Cochrane, MEDLINE, and EMBASE.
- Non-inferiority analysis with a 20% margin was performed.
Main Results:
- Five RCTs involving 901 patients were analyzed.
- Antibiotic treatment achieved a cure rate of 73.4% within two weeks.
- Appendectomy resulted in a cure rate of 97.4% within two weeks.
Conclusions:
- The study's primary outcome was inconclusive due to the upper confidence interval crossing the non-inferiority margin.
- Low to moderate study quality necessitates cautious interpretation of results.
- Appendectomy remains the standard; antibiotic treatment may be an alternative in specific cases or future high-quality RCTs.
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