BMJ. Published online April 5, 2012.

Antibiotics are a safe and effective treatment for patients with uncomplicated acute appendicitis and should be considered as an initial treatment for patients with uncomplicated appendicitis, according to the results of a new meta-analysis. However, critics express concern that the recurrence rate after antibiotic treatment is too high for it to become a new gold standard treatment.

The authors analyzed the results of 4 randomized controlled trials involving 900 adult patients diagnosed with uncomplicated acute appendicitis. A total of 470 patients received antibiotics, and 430 underwent surgery. Patients who received antibiotic therapy had a 63% (277/438) success rate at 1 year.

The meta-analysis also showed a relative risk reduction from complications of 31% for antibiotic treatment compared with appendectomy (Mantel-Haenszel fixed risk ratio, 0.69; 95% confidence interval, 0.54 - 0.89; P = .004). A secondary analysis, which excluded the study that allowed crossover between the 2 trial groups, showed a relative risk reduction of 39% for antibiotic therapy (risk ratio, 0.61; 95% confidence interval, 0.40 - 0.92; P = .02) compared with surgery. The authors found no significant difference between the 2 treatment options with regard to length of hospital stay, efficacy of treatment, or risk for complicated appendicitis.

Of the 68 patients readmitted after antibiotic treatment, 3 were successfully retreated with antibiotics, and 65 patients (20%) had an appendectomy. Nine of these patients had perforated appendicitis, and 4 had gangrenous appendicitis.
The authors acknowledge that a more detailed evaluation should be performed to distinguish between the effects of antibiotic treatment on perforated and nonperforated appendicitis.

Link:
http://www.medscape.com/viewarticle/762025?src=mp&spon=18