The NOTA Study (Non Operative Treatment for Acute Appendicitis): Prospective Study on the Efficacy and Safety of Antibiotics (Amoxicillin and Clavulanic Acid) for Treating Patients With Right Lower Quadrant Abdominal Pain and Long-Term Follow-up of Conservatively Treated Suspected Appendicitis

@article{diSaverio2014TheNS,
  title={The NOTA Study (Non Operative Treatment for Acute Appendicitis): Prospective Study on the Efficacy and Safety of Antibiotics (Amoxicillin and Clavulanic Acid) for Treating Patients With Right Lower Quadrant Abdominal Pain and Long-Term Follow-up of Conservatively Treated Suspected Appendicitis},
  author={Salomone di Saverio and A Sibilio and Eleonora Giorgini and Andrea Biscardi and Silvia Villani and Federico Coccolini and Nazareno Smerieri and Michele Pisano and Luca Ansaloni and Massimo Sartelli and Fausto Catena and Gregorio Tugnoli},
  journal={Annals of Surgery},
  year={2014},
  volume={260},
  pages={109–117}
}
Objectives:To assess the safety and efficacy of antibiotics treatment for suspected acute uncomplicated appendicitis and to monitor the long term follow-up of non-operated patients. Background:Right lower quadrant abdominal pain is a common cause of emergency department admission. The natural history of acute appendicitis nonoperatively treated with antibiotics remains unclear. Methods:In 2010, a total of 159 patients [mean AIR (Appendicitis Inflammatory Response) score = 4.9 and mean Alvarado… 
The Study of Non Operative Treatment for Acute Appendicitis (NOTA)
TLDR
The use of antibiotics for suspected acute non complicated appendicitis is effective and may avoid unnecessary appendectomy and close monitoring of patient's clinical condition is mandatory.
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.
Outcomes of Antibiotics as Primary Therapy in Uncomplicated Acute Appendicitis at PUMHS Nawabshah
TLDR
Under proper observation, antibiotic treatment can be safe and effective in un-complicated acute appendicitis with reduced recurrence under proper observation.
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.
Composite Criteria for Non-Operative Management of Acute Non-Complicated Appendicitis Result in Low Failure Rates
TLDR
A well calculated patient treatment allocation in non-complicated AA can advocate for wide-spread use of the conservative approach, and a well calculated protocol for non-surgical management of non-Complicated AA results in a low failure rate.
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.
A National Evaluation of the Conservative Management of Uncomplicated Acute Appendicitis: How Common Is This and What Are the Issues?
TLDR
Considerable variation in management of uncomplicated appendicitis remains in Ireland despite growing evidence suggesting that the non-operative approach is safe.
Appendectomy versus non-operative treatment for acute uncomplicated appendicitis in children: study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial
TLDR
The APPY trial will be the first multicentre randomised trial comparing non-operative treatment with appendectomy for acute uncomplicated appendicitis in children, and has the potential to revolutionise the treatment of this common gastrointestinal emergency.
Is surgical treatment necessary for uncomplicated acute appendicitis?
TLDR
Appendectomy may be more effective than antibiotics at reducing treatment failure including recurrence, but may be less effective at reducing some complications including wound infection, with uncomplicated acute appendicitis.
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.
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References

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The NOTA study: non-operative treatment for acute appendicitis: prospective study on the efficacy and safety of antibiotic treatment (amoxicillin and clavulanic acid) in patients with right sided lower abdominal pain
TLDR
The relapse rate of patients who have, instead, been selected for a given treatment based on a thorough clinical evaluation, including physical examination and laboratory results (Alvarado Score) as well as radiological exams if needed or deemed helpful is known.
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.
A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon).
TLDR
The conservative management of complicated appendicitis is associated with a decrease in complication and reoperation rate compared with acute appendectomy, and it has a similar duration of hospital stay.
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.
Nonsurgical Treatment of Appendiceal Abscess or Phlegmon: A Systematic Review and Meta-analysis
TLDR
The results of this review of mainly retrospective studies support the practice of nonsurgical treatment without interval appendectomy in patients with appendiceal abscess or phlegmon.
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.
The Natural History and Traditional Management of Appendicitis Revisited: Spontaneous Resolution and Predominance of Prehospital Perforations Imply That a Correct Diagnosis is More Important Than an Early Diagnosis
The principle of early exploration on wide indications in order to prevent perforation has been the guiding star for the management of patients with suspected appendicitis for over 100 years, dating
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.
Meta-analysis of randomized trials comparing antibiotic therapy with appendectomy for acute uncomplicated (no abscess or phlegmon) appendicitis.
TLDR
Non-operative management of uncomplicated appendicitis with antibiotics was associated with significantly fewer complications, better pain control, and shorter sick leave, but overall had inferior efficacy because of the high rate of recurrence in comparison with appendectomy.
Increased use of pre-operative imaging and laparoscopy has no impact on clinical outcomes in patients undergoing appendicectomy.
TLDR
It is shown that significant increase in the use of pre-operative imaging and laparoscopy in the management of patients with acute appendicitis failed to reduce negative appendicectomy, perforation and complications rates.
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