Aller à la navigation principale
Skip notifications
À compter du 1er décembre 2023, l’accès à POEMs et à Essential Evidence Plus ne fera plus partie des avantages offerts aux membres de l’AMC.
Search
Quality of life no different after antibiotics vs surgery for appendicitis, but 30% still require surgery in 90 days
Question clinique
As compared with surgery, does treatment with antibiotics for acute appendicitis affect quality of life at 30 days?
L’Essentiel
Antibiotics are an effective alternative, as compared with surgery, for the treatment of acute appendicitis with regard to short-term quality of life. Although patients managed with antibiotics required more health care visits following treatment, 70% were able to avoid surgery within 90 days. A subset of patients with appendicoliths were more likely to require appendectomy and have complications following antibiotic treatment. These patients may need further consideration for initial surgical treatment. 1b
Référence
Plan de l'etude: Randomized controlled trial (nonblinded)
Financement: Foundation
Cadre: Inpatient (any location)
Sommaire
Although 95% of patients in the United States with appendicitis undergo appendectomy, antibiotic therapy is an alternative treatment. These investigators randomized adults presenting to emergency departments with acute appendicitis (confirmed by imaging) to receive either antibiotic therapy or surgery. Patients with septic shock, diffuse peritonitis, complicated or recurrent appendicitis, or evidence of cancer were excluded. Patients in the antibiotic group (n = 776) received an intravenous antibiotic for at least 24 hours, followed by an oral antibiotic, for a 10-day total course. Patients in the surgery group (n = 776) underwent appendectomy, mostly laparascopic, followed by routine postoperative care. The 2 groups had similar socioeconomic and clinical characteristics at baseline. The primary outcome, a standard quality of life measure, was statistically similar in the 2 groups at 30 days, consistent with noninferiority of antibiotics to surgery. The antibiotic group has fewer missed work days (5.26 days vs 8.73 days), but more visits to the emergency department (9% vs 4%) and more hospitalizations (24% vs 5%) within 90 days of the index treatment. Overall, 29% of the antibiotic group underwent surgery by 90 days. A subgroup of patients with appendicoliths had similar quality of life results when comparing antibiotic treatment with surgery. However, when compared with patients without appendicoliths, these patients were more likely to require appendectomy at 90 days (41% vs 25%) and have a higher rate of complications (20.2 vs 3.6 per 100 participants).
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Commentaires
Antibiotic treatment of appendicitis
I have been reading copiously on this topic. I only have one comment. One of the first cases in our city which was treated with antibiotics developed pseuomembranous colitis , did not respond to normal treatment , and ended up with a total colectomy. I realize that one cases does not make a series , but what a disastrous outcome. All this because the surgeon didn’t want to disrupt his routine. Not good
antibiotics
I have seen this used for appendicitis only rarely.
Antibiotics are an effective alternative to surgery for shor
What a difference a few years makes. In 1994 the goalie Patrick Roy, playing for the Montreal Canadiens, developed acute appendictis during the Stanley Cup playoffs. He convinced his doctors to load him up with antibiotics and let him play. He stopped 39 shots in game 4, helping the Canadiens win 5-2. A few days later he returned to hospital for surgery. At the time, surgeons considered the treatment of appendicitis by antibiotics daring.
antibiotics and appendicitis
As a surgeon, I am not entirely sure what to think of this. Appendectomy for appendicitis is a definitive procedure. Having had an appendectomy as a surgeon, and having my eldest son recover after an appendectomy, I can attest that it is truly a transformative procedure - one feels better so remarkably quickly and has the assurance that the pathology has been dealt with and cannot recur.
I was back to work within a week and my son returned to school after the weekend.
Having seen patients come back with recurrent appendicitis after they have had an attempt at antibiotic therapy does not make for enjoyable surgery and seems to have a higher risk of more complications after surgery than a surgery first approach.
Those who argue against surgery might say that there is a risk of bowel obstruction after surgery from adhesions - that also exists after recovering from any intraabdominal inflammatory condition - including appendicitis.
While I am not absolutely against the idea of an attempt at antibiotic therapy is certain cases; please do not consult this surgeon for his opinion if he would recommend antibiotics for the case. If that is what you want to do, then go ahead and I will do the appendectomy if antibiotic therapy should fail.
Antibiotics for appendicitis
Very good
Providing statistics like this is most helpful in discussing with patients
Locally we always operate if there is a fecolith