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10-04-2012 | Surgery | Article

Antibiotic treatment ‘merits consideration’ for acute appendicitis

Abstract

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MedWire News: Researchers say antibiotics are a safe and efficacious alternative to appendicectomy for treating acute appendicitis.

Dileep Lobo and colleagues from Nottingham University Hospitals, in the UK, compared the two treatment approaches by conducting a meta-analysis of four randomized controlled trials of adult patients diagnosed with uncomplicated acute appendicitis.

"Appendicectomy has been the mainstay for the treatment for acute appendicitis since it was first reported by McBurney in 1889," explain the researchers.

However, "the role of antibiotic treatment in acute uncomplicated appendicitis may have been overlooked mainly on the basis of tradition rather than evidence, considering that other intra-abdominal inflammatory processes such as colonic diverticulitis are primarily managed non-operatively," they add.

A total of 900 patients were included in the analysis, which is published in the BMJ; 470 patients were treated with antibiotics and 430 with appendicectomy.

The researchers found a 39% reduction in the relative risk for complications in the antibiotics treatment group compared with the appendicectomy group, after exclusion of data from the study where crossover had occurred between patient treatment groups. Complications were defined as perforated or gangrenous appendicitis or peritonitis and wound infection. There was no difference between the two groups regarding risk for developing complicated appendicitis.

The number of patients who were treated successfully in these four studies ranged between 44% and 85% for those given antibiotic treatment and between 85% and 100% for those treated surgically.

There was no significant difference in length of hospital stay between the two groups.

Lobo and team conclude: "This meta-analysis of four randomised controlled trials comparing antibiotic treatment and appendicectomy for uncomplicated acute appendicitis showed that antibiotics can be used safely as primary treatment in patients presenting with acute uncomplicated appendicitis... An early trial of antibiotics merits consideration as the initial treatment option for uncomplicated appendicitis."

In an accompanying editorial, Olaf Bakker of the University Medical Centre Utrecht, the Netherlands, is of the opinion that Lobo et al "have dealt with this difficult and controversial question well."

He says: "They are appropriately circumspect in concluding that conservative treatment merits consideration as a primary treatment option.

"However, until more convincing studies and longer term results are published, appendicectomy will probably continue to be used for uncomplicated appendicitis."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Chloe McIvor

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