Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2012 Apr 5:344:e2156.
doi: 10.1136/bmj.e2156.

Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials

Krishna K Varadhan  1 , Keith R Neal, Dileep N Lobo
Affiliations
Meta-Analysis

Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials

Krishna K Varadhan et al. BMJ. .

Abstract

Objective: To compare the safety and efficacy of antibiotic treatment versus appendicectomy for the primary treatment of uncomplicated acute appendicitis.

Design: Meta-analysis of randomised controlled trials.

Population: Randomised controlled trials of adult patients presenting with uncomplicated acute appendicitis, diagnosed by haematological and radiological investigations.

Interventions: Antibiotic treatment versus appendicectomy.

Outcome measures: The primary outcome measure was complications. The secondary outcome measures were efficacy of treatment, length of stay, and incidence of complicated appendicitis and readmissions.

Results: Four randomised controlled trials with a total of 900 patients (470 antibiotic treatment, 430 appendicectomy) met the inclusion criteria. Antibiotic treatment was associated with a 63% (277/438) success rate at one year. Meta-analysis of complications showed a relative risk reduction of 31% for antibiotic treatment compared with appendicectomy (risk ratio (Mantel-Haenszel, fixed) 0.69 (95% confidence interval 0.54 to 0.89); I(2)=0%; P=0.004). A secondary analysis, excluding the study with crossover of patients between the two interventions after randomisation, showed a significant relative risk reduction of 39% for antibiotic therapy (risk ratio 0.61 (0.40 to 0.92); I(2)=0%; P=0.02). Of the 65 (20%) patients who had appendicectomy after readmission, nine had perforated appendicitis and four had gangrenous appendicitis. No significant differences were seen for treatment efficacy, length of stay, or risk of developing complicated appendicitis.

Conclusion: Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Fig 1 PRISMA flow diagram
None
Fig 2 Treatment outcome: antibiotics
None
Fig 3 Treatment outcome: appendicectomy
None
Fig 4 Antibiotic treatment versus appendicectomy for uncomplicated appendicitis: forest plot for complications
None
Fig 5 Antibiotic therapy versus appendicectomy for uncomplicated appendicitis: forest plot for length of primary hospital stay
None
Fig 6 Antibiotic therapy versus appendicectomy for uncomplicated appendicitis: forest plot for risk of complicated appendicitis
See this image and copyright information in PMC

Comment in

References

    1. McBurney C. Experiences with early operative interference in cases of disease of the vermiform appendix. NY Med J 1889;50:1676-84. - PubMed
    1. Fitz RH. Perforating inflammation of the vermiform appendix. Am J Med Sci 1886;92:246-321.
    1. Coursey CA, Nelson RC, Patel MB. Do more preoperative CT scans mean fewer negative appendectomies? A 10 year study. Radiology 2010;254:460-8. - PubMed
    1. Konstantinidis KM, Anastasakou KA, Vorias MN, Sambalis GH, Georgiou MK, Xiarchos AG. A decade of laparoscopic appendectomy: presentation of 1026 patients with suspected appendicitis treated in a single surgical department. J Laparoendosc Adv Surg Tech A 2008;18:248-58. - PubMed
    1. Ming PC, Yan TY, Tat LH. Risk factors of postoperative infections in adults with complicated appendicitis. Surg Laparosc Endosc Percutan Tech 2009;19:244-8. - PubMed

Publication types

Substances