Antibiotics vs. Appendectomy for Acute Uncomplicated Appendicitis in Adults: Review of the Evidence and Future Directions.
Surg Infect (Larchmt)
; 18(5): 527-535, 2017 Jul.
Article
in En
| MEDLINE
| ID: mdl-28614043
ABSTRACT
BACKGROUND:
Acute appendicitis is the most common abdominal surgical emergency in the United States, with a lifetime risk of 7%-8%. The treatment paradigm for complicated appendicitis has evolved over the past decade, and many cases now are managed by broad-spectrum antibiotics. We determined the role of non-operative and operative management in adult patients with uncomplicated appendicitis.METHODS:
Several meta-analyses have attempted to clarify the debate. Arguably the most influential is the Appendicitis Acuta (APPAC) Trial.RESULTS:
According to the non-inferiority analysis and a pre-specified non-inferiority margin of -24%, the APPAC did not demonstrate non-inferiority of antibiotics vs. appendectomy. Significantly, however, the operations were nearly always open, whereas the majority of appendectomies in the United States are done laparoscopically; and laparoscopic and open appendectomies are not equivalent operations. Treatment with antibiotics is efficacious more than 70% of the time. However, a switch to an antimicrobial-only approach may result in a greater probability of antimicrobial-associated collateral damage, both to the host patient and to antibiotic susceptibility patterns. A surgery-only approach would result in a reduction in antibiotic exposure, a consideration in these days of focus on antimicrobial stewardship.CONCLUSION:
Future studies should focus on isolating the characteristics of appendicitis most susceptible to antibiotics, using laparoscopic operations as controls and identifying long-term side effects such as antibiotic resistance or Clostridium difficile colitis.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Appendicitis
/
Drug Utilization
/
Anti-Bacterial Agents
Type of study:
Guideline
/
Prognostic_studies
/
Systematic_reviews
Limits:
Humans
Language:
En
Journal:
Surg Infect (Larchmt)
Journal subject:
BACTERIOLOGIA
Year:
2017
Document type:
Article