Antibiotics vs. Appendectomy for Acute Uncomplicated Appendicitis in Adults: Review of the Evidence and Future Directions

Jared M. Huston, Lillian S. Kao, Phillip K. Chang, James M. Sanders, Sara Buckman, Charles A. Adams, Christine S Cocanour, Sarah E. Parli, Julia Grabowski, Jose Diaz, Jeffrey M. Tessier, Therese M. Duane

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)527-535
Number of pages9
JournalSurgical Infections
Volume18
Issue number5
DOIs
StatePublished - Jul 1 2017

Keywords

  • antibiotics
  • appendectomy
  • appendicitis
  • uncomplicated

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases

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