Appendectomy versus antibiotic treatment for acute appendicitis.

Area of Science:

• General Surgery
• Infectious Diseases

Background:

• Acute appendicitis is a common surgical emergency.
• Treatment options include appendectomy or antibiotics for uncomplicated cases.
• Antibiotics may reduce complications and hospital stay, but recurrence is a concern.

Purpose of the Study:

• To compare antibiotic treatment versus appendectomy for uncomplicated acute appendicitis.
• To assess symptom resolution and complication rates.

Main Methods:

• Systematic review of parallel-group randomized controlled trials (RCTs).
• Searched multiple databases (CENTRAL, MEDLINE, Embase) and trial registers.
• Included adult participants with uncomplicated appendicitis, comparing antibiotics to appendectomy.

Main Results:

• Uncertainty in mortality and major complications due to very low-certainty evidence.
• Antibiotics may increase unsuccessful treatment rates (76/1000) but reduce wound infections.
• Approximately 30.7% of antibiotic-treated patients required appendectomy within one year; evidence is very uncertain.

Conclusions:

• Antibiotic treatment for uncomplicated appendicitis has uncertain outcomes regarding treatment success and hospital stay.
• A significant proportion of patients treated with antibiotics may require appendectomy later.
• Antibiotics may reduce wound infections but increase the rate of negative appendectomies.