Antibiotics Versus Surgical Therapy for Uncomplicated Appendicitis: Systematic Review and Meta-analysis of Controlled Trials (PROSPERO 2015 CRD42015016882)

@article{Harnoss2017AntibioticsVS,
  title={Antibiotics Versus Surgical Therapy for Uncomplicated Appendicitis: Systematic Review and Meta-analysis of Controlled Trials (PROSPERO 2015 CRD42015016882)},
  author={Julian Camill Harnoss and Isabelle Zelienka and Pascal Probst and Kathrin Grummich and Catharina M{\"u}ller-Lantzsch and Jonathan M. Harnoss and Alexis B Ulrich and Markus W. B{\"u}chler and Markus K. Diener},
  journal={Annals of Surgery},
  year={2017},
  volume={265},
  pages={889–900}
}
Objective: The aim was to investigate available evidence regarding effectiveness and safety of surgical versus conservative treatment of acute appendicitis. Summary of Background Data: There is ongoing debate on the merits of surgical and conservative treatment for acute appendicitis. Methods: A systematic literature search (Cochrane Library, Medline, Embase) and hand search of retrieved reference lists up to January 2016 was conducted to identify randomized and nonrandomized studies. After… Expand
Meta-analysis of studies comparing conservative treatment with antibiotics and appendectomy for acute appendicitis in the adult
TLDR
For both uncomplicated and complicated adult AA, non-operative management with antibiotics was associated with significantly fewer complications and a shorter length of stay but a lower effective rate and higher relapse rate. Expand
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TLDR
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This meta-analysis shows that appendectomy is more effective than antibiotic therapy for definitive cure of acute uncomplicated appendicitis, and since the incidence of complications does not differ between the two treatments, antibiotic therapy might be a reasonable alternative for selected patients. Expand
Antibiotic Treatment and Appendectomy for Uncomplicated Acute Appendicitis in Adults and Children: A Systematic Review and Meta-analysis.
MINI: The present meta-analysis demonstrates that, although limited by a lower efficacy compared to surgery, NOM with antibiotics could be considered a safe option for adults and pediatric patientsExpand
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TLDR
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TLDR
The major primary outcomes show a high recurrence rate and failed treatment associated with the conservative management of appendicitis, and economic implications and cost-effectiveness analysis show that conservative treatment may be preferred. 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
Antibiotics Versus Appendicectomy for the Treatment of Uncomplicated Acute Appendicitis: An Updated Meta-Analysis of Randomised Controlled Trials by Rollins et al.
TLDR
In conclusion, surgery represents a final treatment with a clear risk profile and important factors on antibiotic therapy are yet uninvestigated (e.g. quality of life). Expand
Laparoscopic appendectomy vs antibiotic therapy for acute appendicitis: a propensity score-matched analysis from a multicenter cohort study
TLDR
Due to the low rates of complications occurred in the ST group and the high efficacy of the surgical therapy, laparoscopic appendectomy still represents the most effective treatment for patients with AA. Expand
A prospective non-randomized controlled, multicenter trial comparing Appendectomy and Conservative Treatment for Patients with Uncomplicated Acute Appendicitis (the ACTUAA study)
TLDR
A comparison will be made between surgical and antibiotic-first approaches to uncomplicated AA through the analysis of the primary outcome measure of complication-free treatment success rate based on 1-year follow-up. Expand
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References

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Antibiotic Therapy Versus Appendectomy for Acute Appendicitis: A Meta-Analysis
TLDR
This meta-analysis of RCTs of antibiotic therapy versus surgery showed a trend toward a reduced risk of complications in the antibiotic-treated group, suggesting that appendectomy is still the gold standard therapy for acute appendicitis. Expand
Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials
TLDR
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
Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial.
TLDR
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
Appendectomy versus Antibiotic Treatment in Acute Appendicitis: A Prospective Multicenter Randomized Controlled Trial
TLDR
Although the issue is still controversial, laparoscopic appendectomy reportedly offers less postoperative pain and earlier return to work, and the authors state that elderly patients with concomitant problems may be offered antibiotic treatment, they present no data to support this statement. Expand
Appendectomy versus antibiotic treatment for acute appendicitis.
TLDR
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
Laparoscopic versus open surgery for suspected appendicitis.
TLDR
While the operation costs of LA were significantly higher than that of OA, the costs outside hospital were reduced, and diagnostic laparoscopy and LA (either in combination or separately) seem to have various advantages over OA. Expand
Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial
TLDR
Amoxicillin plus clavulanic acid was not non-inferior to emergency appendicectomy for treatment of acute appendicitis and Identification of predictive markers on CT scans might enable improved targeting of antibiotic treatment. Expand
Comparison of operative and non operative management of acute appendicitis.
TLDR
Medical treatment seems to be a good alternative to the gold standard therapy of surgery in management of acute appendicitis with its high success rate and cost effectiveness. Expand
Efficacy of Short-Term Antibiotic Therapy for Consecutive Patients with Mild Appendicitis
TLDR
Patients with suspected appendicitis, those in whom mild appendiciti was diagnosed after clinical and radiologic evaluations, were found to benefit from short-term antibiotic therapy. Expand
Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis
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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