Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis

Abstract

Background: The use of antibiotics alone in the treatment of uncomplicated acute appendicitis has been controversial. The present report is based on a systematic review and meta-analysis of existing studies that compared antibiotics treatment to appendectomy in patients with uncomplicated acute appendicitis.

Methods: A Medline search was performed for studies published between 1970 and 2009. Studies were selected based on specific inclusion and exclusion criteria. Six reports comprised of 1,201 patients were analyzed.

Results: In patients treated with antibiotics alone, 6.9 ± 4.4% failed to respond and required appendectomy, and acute appendicitis recurred in 14.2 ± 10.6%. One appendectomy patient had a recurrence. A normal appendix was found in 7.3 ± 5.1% of patients at appendectomy. Complications were considerably less likely to occur with antibiotic treatment than with appendectomy. Major surgical complications included enterocutaneous fistula and reoperation.

Conclusion: In some cases, antibiotic treatment may fail, and there is a risk of recurrence. However, surgically treated patients, including those with the potential for spontaneous resolution and those with a normal appendix, are subjected to the risks of operative morbidity and mortality. Antibiotic therapy incurs significantly fewer complications. Prospective randomized studies are urgently needed to conclusively define the roles of appendectomy and antibiotic treatment in the management of uncomplicated acute appendicitis.