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 article

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 2017
Externally publishedYes

Keywords

  • antibiotics
  • appendectomy
  • appendicitis
  • uncomplicated

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases

Fingerprint Dive into the research topics of 'Antibiotics vs. Appendectomy for Acute Uncomplicated Appendicitis in Adults: Review of the Evidence and Future Directions'. Together they form a unique fingerprint.

  • Cite this

    Huston, J. M., Kao, L. S., Chang, P. K., Sanders, J. M., Buckman, S., Adams, C. A., Cocanour, C. S., Parli, S. E., Grabowski, J., Diaz, J., Tessier, J. M., & Duane, T. M. (2017). Antibiotics vs. Appendectomy for Acute Uncomplicated Appendicitis in Adults: Review of the Evidence and Future Directions. Surgical Infections, 18(5), 527-535. https://doi.org/10.1089/sur.2017.073