A meta-analysis published in the British Medical Journal of four randomised controlled trials including 900 adult patients ( > 18 years ) compared 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. Antibiotic treatment was not associated with an increased perforation rate compared with surgery, nor were any significant differences seen in the length of stay or treatment efficacy between antibiotics and appendicectomy. Antibiotic treatment was associated with a 63% success rate and a reduced risk of complications. About 20% of patients who were treated with antibiotics had appendicectomy for recurrence of symptoms, and of these only about one in five had complicated appendicitis.
The authors concluded that an early trial of antibiotics may merit consideration as the initial treatment option for uncomplicated appendicitis. They suggested that the possibility that perforated and non-perforated appendicitis could have different patterns and pathological processes needs further evaluation. Future studies may show if uncomplicated acute appendicitis should be treated in a similar fashion as other conditions such as acute colonic diverticulitis in which antibiotic treatment plays an important role.
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