Conclusion The paradigm remains unchanged , that appendectomy is the gold st and ard of treatment for uncomplicated appendicitis , given its higher efficacy rate when compared to NOM
Introduction Appendectomy has long been the mainstay of intervention for acute appendicitis , aim ing at preventing perforation , peritonitis , abscess formation and recurrence .
With better underst and ing of the disease process , non-operative management ( NOM ) with antibiotics alone has been proved a feasible treatment for uncomplicated appendicitis .
This article aim ed at systematic ally review ing the available literature s and discussing the question whether NOM should replace appendectomy as the st and ard first-line treatment for uncomplicated appendicitis .
Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial
BACKGROUND Research ers have suggested that antibiotics could cure acute appendicitis . We assessed the efficacy of amoxicillin plus clavulanic acid by comparison with emergency appendicectomy for treatment of patients with uncomplicated acute appendicitis . METHODS In this open-label , non-inferiority , r and omised trial , adult patients ( aged 18 - 68 years ) with uncomplicated acute appendicitis , as assessed by CT scan , were enrolled at six university hospitals in France . A computer-generated r and omisation sequence was used to allocate patients r and omly in a 1:1 ratio to receive amoxicillin plus clavulanic acid ( 3 g per day ) for 8 - 15 days or emergency appendicectomy . The primary endpoint was occurrence of postintervention peritonitis within 30 days of treatment initiation . Non-inferiority was shown if the upper limit of the two-sided 95 % CI for the difference in rates was lower than 10 percentage points . Both intention-to-treat and per- protocol analyses were done . This trial is registered with Clinical Trials.gov , number NCT00135603 . FINDINGS Of 243 patients r and omised , 123 were allocated to the antibiotic group and 120 to the appendicectomy group . Four were excluded from analysis because of early dropout before receiving the intervention , leaving 239 ( antibiotic group , 120 ; appendicectomy group , 119 ) patients for intention-to-treat analysis . 30-day postintervention peritonitis was significantly more frequent in the antibiotic group ( 8 % , n=9 ) than in the appendicectomy group ( 2 % , n=2 ; treatment difference 5·8 ; 95 % CI 0·3 - 12·1 ) . In the appendicectomy group , despite CT-scan assessment , 21 ( 18 % ) of 119 patients were unexpectedly identified at surgery to have complicated appendicitis with peritonitis . In the antibiotic group , 14 ( 12 % [ 7·1 - 18·6 ] ) of 120 underwent an appendicectomy during the first 30 days and 30 ( 29 % [ 21·4 - 38·9 ] ) of 102 underwent appendicectomy between 1 month and 1 year , 26 of whom had acute appendicitis ( recurrence rate 26 % ; 18·0 - 34·7 ) . INTERPRETATION Amoxicillin plus clavulanic acid was not non-inferior to emergency appendicectomy for treatment of acute appendicitis . Identification of predictive markers on CT scans might enable improved targeting of antibiotic treatment .  FUNDING French Ministry of Health , Programme Hospitalier de Recherche Clinique 2002
Conclusion The paradigm remains unchanged , that appendectomy is the gold st and ard of treatment for uncomplicated appendicitis , given its higher efficacy rate when compared to NOM
Introduction Appendectomy has long been the mainstay of intervention for acute appendicitis , aim ing at preventing perforation , peritonitis , abscess formation and recurrence .
With better underst and ing of the disease process , non-operative management ( NOM ) with antibiotics alone has been proved a feasible treatment for uncomplicated appendicitis .
This article aim ed at systematic ally review ing the available literature s and discussing the question whether NOM should replace appendectomy as the st and ard first-line treatment for uncomplicated appendicitis .