Antibiotics Versus Appendicectomy for the Treatment of Uncomplicated Acute Appendicitis: An Updated Meta-Analysis of Randomised Controlled Trials

@article{Rollins2016AntibioticsVA,
  title={Antibiotics Versus Appendicectomy for the Treatment of Uncomplicated Acute Appendicitis: An Updated Meta-Analysis of Randomised Controlled Trials},
  author={Katie E. Rollins and Krishna K. Varadhan and Keith R. Neal and Dileep N. Lobo},
  journal={World Journal of Surgery},
  year={2016},
  volume={40},
  pages={2305-2318}
}
BackgroundUncomplicated acute appendicitis has been managed traditionally by early appendicectomy. However, recently, there has been increasing interest in the potential for primary treatment with antibiotics, with studies finding this to be associated with fewer complications than appendicectomy. The aim of this study was to compare outcomes of antibiotic therapy with appendicectomy for uncomplicated acute appendicitis.MethodThis meta-analysis of randomised controlled trials included adult… Expand
Appendectomy versus Conservative Antibiotics Treatment for Non-Complicated Acute Appendicitis : A Meta-Analysis of Randomized Controlled Trials
Purpose: In this meta-analysis, we compared the safety and efficacy of antibiotic treatment with appendectomy for the primary treatment of uncomplicated acute appendicitis. Methods: A comprehensiveExpand
Antibiotics-first strategy for uncomplicated acute appendicitis in adults is associated with increased rates of peritonitis at surgery. A systematic review with meta-analysis of randomized controlled trials comparing appendectomy and non-operative management with antibiotics.
TLDR
With significantly higher efficacy and low complication rates, appendectomy remains the most effective treatment for patients with uncomplicated AA and the subgroups of patients where antibiotics can be more effective, should be accurately identified. Expand
Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and meta-analysis
TLDR
Conservative treatment was less efficacious and was associated with a higher readmission rate and index admission appendicectomy should in the present still be considered to be the treatment of choice for the management of uncomplicated appendicitis in children. Expand
The current management of acute uncomplicated appendicitis: should there be a change in paradigm? A systematic review of the literatures and analysis of treatment performance
TLDR
The paradigm remains unchanged, that appendectomy is the gold standard of treatment for uncomplicated appendicitis, given its higher efficacy rate when compared to NOM. Expand
Cost analysis of antibiotic therapy versus appendectomy for treatment of uncomplicated acute appendicitis: 5-year results of the APPAC randomized clinical trial
TLDR
It is suggested that treating uncomplicated acute appendicitis with antibiotics instead of appendectomy results in lower overall costs even at longer-term follow-up, as the majority of appendix recurrences occur within the first year after the initial antibiotic treatment. Expand
Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial
TLDR
A long-term follow-up of patients in the Appendicitis Acuta multicenter randomized clinical trial supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis. Expand
Antibiotics vs. Appendectomy for Acute Uncomplicated Appendicitis in Adults: Review of the Evidence and Future Directions.
TLDR
Future studies should focus on isolating the characteristics of appendicitis most susceptible to antibiotics, using laparoscopic operations as controls and identifying long-term side effects such as antibiotic resistance or Clostridium difficile colitis. Expand
Nonoperative management in children with early acute appendicitis: A systematic review.
TLDR
Although present literature is scarce, publications support the feasibility of further studies investigating NOM of acute uncomplicated appendicitis in children, and higher quality prospective RCTs with larger sample sizes and robust randomization methods are required to establish its utility. Expand
Initial non-operative management of uncomplicated appendicitis in children: a protocol for a multicentre randomised controlled trial (APAC trial)
TLDR
This multicentre, non-inferiority, randomised controlled trial randomises children aged 7–17 years with imaging-confirmed simple appendicitis between appendectomy and NOT and reports on the rate of complications at 1-year follow-up. Expand
The efficacy of antibiotic treatment versus surgical treatment of uncomplicated acute appendicitis: Systematic review and network meta-analysis of randomized controlled trial.
TLDR
Appendectomy is still the most effective treatment in uncomplicated appendicitis but it carries complications, and Beta-lactamase, might be an alternative treatment if there are any contraindications for operation. Expand
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Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis and initial antibiotic treatment merits consideration as a primary treatment option for early uncomplication appendiciti. Expand
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Suspected uncomplicated appendicitis has a lower rate of major post-intervention complications when managed with primary appendicectomy compared to antibiotic therapy. Expand
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Most patients randomized to antibiotic treatment for uncomplicated appendicitis did not require appendectomy during the 1-year follow-up period, and those who required appendectomy did not experience significant complications, despite the prespecified noninferiority margin. Expand
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This pilot trial suggests that nonoperatively treatment of acute appendicitis in children is feasible and safe and that further investigation of nonoperative treatment is warranted. Expand
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It is concluded that appendectomy remains the standard treatment for acute appendicitis and antibiotic treatment might be used as an alternative treatment in a good quality RCT or in specific patients or conditions were surgery is contraindicated. Expand
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Antibiotic therapy without surgery may be a safe treatment for uncomplicated appendicitis in select patients with appendiceal diameters ≤ 10 mm. Expand
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After 2 years of follow-up, recurrences of nonoperatively treated right lower quadrant abdominal pain are less than 14% and may be safely and effectively treated with further antibiotics. Expand
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TLDR
Antibiotic treatment in patients with acute appendicitis was as effective as surgery, and the patients had less pain and required less analgesia, but the recurrence rate was high. Expand
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Considerable variation in management of uncomplicated appendicitis remains in Ireland despite growing evidence suggesting that the non-operative approach is safe. Expand
Initial antibiotic treatment for acute simple appendicitis in children is safe: Short-term results from a multicenter, prospective cohort study.
TLDR
The study shows that an RCT comparing initial antibiotic treatment strategy with urgent appendectomy is feasible in children and the intervention seems to be safe. Expand
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