Document Detail


Antibiotics as first-line therapy for acute appendicitis: evidence for a change in clinical practice.
MedLine Citation:
PMID:  22569747     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Randomized studies have indicated that acute appendicitis may be treated by antibiotics without the need of surgery. However, concerns have been raised about selection bias of patients in such studies. Therefore, the present study was aimed to validate previous findings in randomized studies by a full-scale population-based application.
METHODS: All patients with acute appendicitis at Sahlgrenska University Hospital (May 2009 and February 2010) were offered intravenous piperacillin plus tazobactam according to our previous experience, followed by 9 days out-hospital oral ciprofloxacin plus metronidazole. Endpoints were treatment efficacy and complications. Efficient antibiotic treatment was defined as recovery without the need of surgery beyond 1 year of follow-up.
RESULTS: A total of 558 consecutive patients were hospitalized and treated due to acute appendicitis. Seventy-nine percent (n = 442) received antibiotics as first-line therapy and 20 % (n = 111) had primary surgery as the second-line therapy. Seventy-seven percent of patients on primary antibiotics recovered while 23 % (n = 100) had subsequent appendectomy due to failed initial treatment on antibiotics. Thirty-eight patients (11 %) of the 342 had experienced recurrent appendicitis at 1-year follow-up. Primary antibiotic treatment had fewer complications compared to primary surgery.
CONCLUSIONS: This population-based study confirms previous results of randomized studies. Antibiotic treatment can be offered as the first-line therapy to a majority of unselected patients with acute appendicitis without medical drawbacks other than the unknown risk for long-term relapse, which must be weighed against the unpredicted but well-known risk for serious major complications following surgical intervention.
Authors:
Jeanette Hansson; Ulla Körner; Karin Ludwigs; Erik Johnsson; Claes Jönsson; Kent Lundholm
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  World journal of surgery     Volume:  36     ISSN:  1432-2323     ISO Abbreviation:  World J Surg     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-09     Completed Date:  2012-12-17     Revised Date:  2013-04-15    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2028-36     Citation Subset:  IM    
Affiliation:
Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, 416 85 Goteborg, Sweden.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Administration, Intravenous
Administration, Oral
Adult
Anti-Bacterial Agents / administration & dosage*
Appendicitis / drug therapy*,  surgery
Ciprofloxacin / administration & dosage*
Female
Humans
Male
Metronidazole / administration & dosage*
Penicillanic Acid / administration & dosage,  analogs & derivatives*
Piperacillin / administration & dosage*
Prospective Studies
Randomized Controlled Trials as Topic
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 443-48-1/Metronidazole; 61477-96-1/Piperacillin; 85721-33-1/Ciprofloxacin; 87-53-6/Penicillanic Acid; SE10G96M8W/tazobactam
Comments/Corrections
Comment In:
World J Surg. 2013 Apr;37(4):932   [PMID:  23196340 ]
World J Surg. 2012 Dec;36(12):2952-3   [PMID:  22875010 ]
World J Surg. 2012 Sep;36(9):2037-8   [PMID:  22638683 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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