Sometimes antibiotics may be more appropriate than appendicectomy

January 01, 0001

Sometimes antibiotics may be more appropriate than appendicectomy

Previous research has suggested that antibiotics could cure acute appendicitis. The researchers from France assessed the efficacy of amoxicillin plus clavulanic acid by comparison with emergency appendicectomy for treatment of patients with uncomplicated acute appendicitis. In this open- label, non-inferiority, randomised trial, adult patients (aged 18—68 years) with uncomplicated acute appendicitis, as assessed by CT scan, were enrolled at six university hospitals in France. Of 243 patients randomised, 123 were allocated to the antibiotic group and 120 to the appendicectomy group.

30-day postintervention peritonitis was significantly more frequent in the antibiotic group (8%) than in the appendicectomy group (2%). In the appendicectomy group, despite CT-scan assessment, 18% patients were unexpectedly identified at surgery to have complicated appendicitis with peritonitis. In the antibiotic group, 12% underwent an appendicectomy during the first 30 days and 29% underwent appendicectomy between 1 month and 1 year, 26 of whom had acute appendicitis (recurrence rate 26%).

The researchers concluded: "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."

Two out of three people with acute appendicitis may be spared an operation initially, with one quarter requiring it later.

For the full abstract, click here.

The Lancet 377(9777):1573-1579, 7 May 2011 © 2011 Elsevier Limited
Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Corinne Vons, Caroline Barry, Sophie Maitre et al. Correspondence to Corinne Vons: [email protected]

Category: D. Digestive. Keywords: amoxicillin, clavulanic acid, appendicectomy, acute, uncomplicated, appendicitis, open-label randomised trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 27 May 2011

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