A Meta-Analysis of Antibiotics Versus Surgery for the Treatment of Acute Appendicitis
American Journal of Bioscience and Bioengineering
Volume 5, Issue 3, June 2017, Pages: 75-82
Received: Jul. 19, 2017;
Accepted: Jul. 31, 2017;
Published: Aug. 18, 2017
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Luai Fadi Madanat, Department of Surgery, School of Medicine, University of Jordan, Amman, Jordan
Dina Wahib Shaban, Department of Surgery, School of Medicine, University of Jordan, Amman, Jordan
Hamzeh Mohamad Naghawi, Department of Surgery, School of Medicine, University of Jordan, Amman, Jordan
Haneen Samir Saker, Department of Surgery, School of Medicine, University of Jordan, Amman, Jordan
Moaath Alsmady, Department of Surgery, School of Medicine, University of Jordan, Amman, Jordan
Handan Ankarali, Department of Biostatistics, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
Tunc Eren, Department of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
Orhan Alimoglu, Department of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
Appendectomy is the mainstay of treatment for acute appendicitis. Considering the complications of surgery, antibiotic treatment has also been gaining increasing interest in cases of acute appendicitis. This study aimed to compare the efficacy of antibiotics to surgery for acute uncomplicated appendicitis. The PubMed, Medline, Medscape and Cochrane databases were searched for studies comparing antibiotics versus surgery. The six outcome measures identified were thirty-day post-therapeutic peritonitis, length of hospital stay, prevalence of total complications, prevalence of normal appendix, prevalence of mean duration of pain and duration of disability. Five prospective RCTs with a total of 1430 patients (644 in the antibiotic group and 786 in the surgical group) were included in this study. Antibiotic treatment had a success rate of 75.3%. Regarding overall mean duration of disability, the antibiotic group had a significantly shorter duration of disability than that of the surgery group (P < 0.05). The total number of complications in the antibiotic group was 3.6% while that of the surgical group was 11.6%. The overall difference for mean duration of pain, and length of hospital stay between antibiotic therapy and surgery were not found to be statistically significant (P > 0.05). Although the conservative approach has a success rate lower than appendectomy, it is a possible alternative in certain clinical scenarios. Appendectomy remains the mainstay treatment for acute appendicitis. However, additional studies clarifying the certain etiologies of appendicitis that are responsive to antibiotic treatment are needed to further support its use.
Luai Fadi Madanat,
Dina Wahib Shaban,
Hamzeh Mohamad Naghawi,
Haneen Samir Saker,
A Meta-Analysis of Antibiotics Versus Surgery for the Treatment of Acute Appendicitis, American Journal of Bioscience and Bioengineering.
Vol. 5, No. 3,
2017, pp. 75-82.
Fitz RH (1886) Perforating inflammation of the vermiform appendix. Am J Med Sci 92: 321-46.
Humes DJ, Simpson J (2006) Acute appendicitis. BMJ 333: 530–4.
Addiss DG, Shaffer N, Fowler BS, et al. (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132(5): 910–25.
Mc Burney C (1889) Experience with early operative interference in cases of disease of the vermiform appendix. N Y Med J 50: 676-84.
Blomqvist P, Ljung H, Nyren O, et al. (1998) Appendectomy in Sweden 1989-1993 assessed by the Inpatient Registry. J Clin Epidemiol 51: 859-65.
O’Connell PR, Williams NS, Bulstrode CJK (2008) The vermiform appendix Bailey and Love’s short practice of surgery. 25th ed. p. 1204-18.
Margenthaler JA, Longo WE, Virgo KS, et al. (2003). Risk factors for adverse outcomes after the surgical treatment of appendicitis in adults. Ann Surg 238: 59-66.
Hale DA, Molloy M, Pearl RH, et al. (1997) Appendectomy: a contemporary appraisal. Ann Surg 225: 252-61.
Colson M, Skinner KA, Dunnington G (1997) High negative appendectomy rates are no longer acceptable. Am J Surg 174: 723-6; discussion 726-7.
Guller U, Jain N, Peterson ED, et al. (2004) Laparoscopic appendectomy in the elderly. Surgery 135: 479-88.
Nakhamiyayev V, Galldin L, Chiarello M, et al. (2009) Laparoscopic appendectomy is the preferred approach for appendicitis: a retrospective review of two practice patterns. Surg Endosc 24(4): 859-864.
Sauerland S, Lefering R, Neugebauer EAM. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database of Systematic Reviews Issue 10.
Harrison, Paul W (1953) Appendicitis and the Antibiotics. Am J Surg 85.2: 160-63.
Coldrey, E (1956) Treatment of Acute Appendicitis. BMJ 2.5007: 1458-461.
No authors listed (1979) Treatment of Acute Abdominal Diseases by Combined Traditional Chinese and Western Medicine. World J Surg 3.1: 91-94.
Whetsone D, Hazey J, Pofahl WE 2nd, et al. (2004) Current management of diverticulitis. Curr Surg 61: 361–365.
Livingston, Edward H (2011) "Epidemiological Similarities between Appendicitis and Diverticulitis Suggesting a Common Underlying Pathogenesis." Arch Surg 146.3: 308.
Adams ML (1990) The medical management of acute appendicitis in a nonsurgical environment: A retrospective case review. Mil Med 155: 345–347.
Liu K, Ahanchi S, Pisaneschi M, et al. (2007) Can acute appendicitis be treated by antibiotics alone? Am Surg 73: 1161–1165.
Winn RD, Laura S, Douglas C, et al. (2004) Protocol-based approach to suspected appendicitis, incorporating the Alvarado score and outpatient antibiotics. NZJ Surg 74: 324–329.
Liu K, Fogg L (2011) Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis. Surgery 150: 673-83.
Ansaloni L, Catena F, Coccolini F, et al. (2011) Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials. Dig Surg 28.3: 210-21
Kirby A, Hobson RP, Burke D, et al. (2015) Appendectomy for suspected uncomplicated appendicitis is associated with fewer complications than conservative antibiotic management: a meta-analysis of post-intervention complications. J Infect. 70: 105–10.
Varadhan KK, Humes DJ, Neal KR, et al. (2010) Antibiotic therapy versus appendectomy for acute appendicitis: a meta-analysis. World J Surg. 34: 199–209.
Higgins JPT, Green SM (2011) Cochrane handbook for systematic reviews of interventions. Copenhagen, Denmark.
Malik AA, Bari S-U. RETRACTED ARTICLE (2009) Conservative Management of Acute Appendicitis. J Gastrointest Surg 13(5): 966–70.
Salminen P, Paajanen H, Rautio T, et al. (2015) Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis. Jama 313(23): 2340.
Eriksson S, Granström L (1995) Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis. Br J Surg 82(2): 166–9.
Hansson J, Körner U, Khorram-Manesh A, et al. (2009) Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg 96(5): 473–81.
Vons C, Barry C, Maitre S, et al. (2011) Amoxicillin plus clavulanic acid versus appendectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. The Lancet 377(9777): 1573–9.
Styrud J, Eriksson S, Nilsson I, et al. (2006) Appendectomy versus Antibiotic Treatment in Acute Appendicitis. A Prospective Multicenter Randomized Controlled Trial. World J Surg 30(6): 1033–7.
Schug-Pass C, Geers P, Hügel O, et al. (2010) Prospective randomized trial comparing short-term antibiotic therapy versus standard therapy for acute uncomplicated sigmoid diverticulitis. Int J Colorectal Dis 25(6): 751-59.
Oteo J, Campos J, Lázaro E, et al. (2008) Increased Amoxicillin–Clavulanic Acid Resistance in Escherichia coli Blood Isolates. Emerg Infect Dis 14(8): 1259–62.
Solomkin JS, Mazuski JE, Beadley JS, et al. (2010) Diagnosis and management of complicated intra-abdominal infection in adults and children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 50(2): 133-64.