Antibiotics were safe and effective as primary treatment for uncomplicated acute appendicitis, according to recent data.
Researchers analyzed 900 patients in four, randomized, controlled trials (470 received antibiotic treatment; 430 had an appendectomy), with complications as the primary outcome measurement. Antibiotics included intravenous or oral amoxicillin plus clavulanic acid (3 g/day or 4 g/day depending on patient’s weight) for 48 hours. Patients underwent appendectomy if there was no resolution after 48 hours.
At 1 year, the antibiotic treatment group had a 63% success rate. A meta-analysis of complications revealed a relative risk reduction of 31% for antibiotic treatment compared with appendectomy (95% CI, 0.54-0.89).
Of the 20% of patients who had been treated with antibiotics and readmitted for appendectomy (n=65), nine had perforated appendicitis and four had gangrenous appendicitis.
“Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis,” the researchers wrote. “Antibiotic treatment was not associated with an increased perforation rate compared with surgery, nor were any significant differences seen in the length of stay or treatment efficacy between antibiotics and [appendectomy].”