Clinical Evidence Handbook

A Publication of BMJ Publishing Group

Appendicitis

 

Am Fam Physician. 2016 Jan 15;93(2):142-143.

Author disclosure: Nigel D'Souza and Karen Nugent declare that they have no competing interests.

Appendicitis is inflammation of the vermiform appendix that may lead to an abscess, ileus, peritonitis, or death if untreated.

Appendicitis is the most common abdominal surgical emergency.

The current standard treatment for uncomplicated appendicitis is usually surgical removal of the appendix (appendectomy), but there has been increasing evidence published on the use of antibiotics.

The evidence comparing surgery with antibiotics is weak and confounded by factors such as inconsistencies with results and outcomes measured, which makes it difficult to compare these interventions.

Appendectomy may be associated with reduced overall treatment failure (including recurrence requiring surgery within one year) in the treatment of adults with acute appendicitis, but may also be associated with an increase in complications and sick days compared with antibiotics.

  • We do not know whether appendectomy and antibiotics differ with regard to hospital stay or improvement in quality-of-life scores.

  • We found no studies reporting outcomes beyond one year, which is a major limitation of the available evidence.

  • All of the evidence we found was in adults; we found no randomized controlled trials (RCTs) in children.

At present, the weight of evidence does not suggest that antibiotics are superior to surgery for treating appendicitis.

There is a lack of high-quality RCTs comparing what might be termed optimal current surgical techniques with optimal current antibiotic regimens. Further trials are underway, which may provide further information on how current surgical techniques compare with current antibiotic regimens when both treatment approaches are optimized.

View/Print Table

Clinical Question

What are the effects of surgery compared with antibiotics for acute appendicitis?

Likely to be beneficial

Surgery vs. antibiotics (increased initial treatment success and decreased recurrence with surgery compared with antibiotics in adults, but may be associated with some increased complications; we found no good evidence in children)

Clinical Question

What are the effects of surgery compared with antibiotics for acute appendicitis?

Likely to be beneficial

Surgery vs. antibiotics (increased initial

Author disclosure: Nigel D'Souza and Karen Nugent declare that they have no competing interests.

This is one in a series of chapters excerpted from the Clinical Evidence Handbook, published by the BMJ Publishing Group, London, U.K. The medical information contained herein is the most accurate available at the date of publication. More updated and comprehensive information on this topic may be available in future print editions of the Clinical Evidence Handbook, as well as online at http://www.clinicalevidence.bmj.com (subscription required).

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.

A collection of Clinical Evidence Handbook published in AFP is available at http://www.aafp.org/afp/bmj.


 

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


Dec 1, 2016

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article