SUNY Downstate Health Sciences University Brooklyn, NY, United States
Bhesh R. Karki, MD1, Dhan B. Shrestha, MD2, Pravash Budhathoki, MD3, Yub Raj Sedhai, MD4, Oshan Shrestha, MBBS5, Sagun Karki, MBBS5, Niranjan Thapa, MBBS5, Chet B. Ranabhat, MBBS6, Paula Ferrada, MD4, Raju Bhandari, MD7 1SUNY Downstate Health Sciences University, Brooklyn, NY; 2Mount Sinai Hospital, Chicago, IL; 3BronxCare Health System, Bronx, NY; 4Virginia Commonwealth University School of Medicine, Richmond, VA; 5Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati, Nepal; 6BP Koirala Institute of Health Sciences, Dharan, Kosi, Nepal; 7Indira Gandhi Memorial Hospital, Maale, Maale, Maldives
Introduction: Acute appendicitis is one of the commonest indications of emergency surgery worldwide. Renewed interest in the non-operative management of acute appendicitis has risen after the revelation of uncomplicated and complicated forms of acute appendicitis. The rationale of non-operative management is to avoid surgical intervention in patients who do not need it. This updated meta-analysis was carried out to compare antibiotic therapy with appendectomy in acute uncomplicated appendicitis (AUA) taking safety and effectiveness into account.
Methods: Meticulous search in multiple electronic databases like Scopus, Embase, PubMed, PubMed Central, and Cochrane library were done in seek of relevant articles. RCTs that were published from 2010 till December 2020 with proper data on the safety and efficacy of the use of antibiotics in AUA were included. Extracted data from included studies were analyzed using RevMan 5.4.
Results: Six out of a total of 4803 searched studies met our inclusion criteria and were included in our analysis. The analysis showed no significant difference in treatment success rate between the two groups (OR, 0.50; CI, 0.11-2.28; p=0.37). Also, no significant difference could be seen in the occurrence of serious morbidities or complications between the two groups (OR, 0.38; CI, 0.06-2.44; p=0.31). Comparisons done for length of hospital stay (MD, 0.10; CI, -1.10 to 1.30; p=0.87) and post-treatment sick leave or disability duration (MD, -4.35; CI, -10.81 to 2.10; p=0.19) also did not show any differences.
Discussion: This meta-analysis showed that antibiotics for AUA can be an option to the surgical treatment. Major concerns with antibiotic treatment were increased recurrence and failure within one year attributed to the presence of fecolith. However, our study validates that antibiotic treatment for AUA has similar treatment efficacy over two weeks as surgical treatment, as shown by prior few studies. Concerns of wound rupture, hernia, adhesion, obstructions, etc. are unshakable with appendectomy, whereas C. difficile infection, change in the intestinal flora, increased antibiotic resistance, and recurrence are the major concerns with antibiotics. The choice of antibiotics influenced the recurrence. The in-hospital stay was not different likely due to inclusion of the CODA trial which is a large study and surgical interventions were laparoscopic. Our study was limited by the small sample size of most of the included studies (except the CODA trial and APPAC).
Figure: Forest plot comparing treatment success rate between antibiotic and appendectomy for uncomplicated appendicitis
Disclosures: Bhesh Karki indicated no relevant financial relationships. Dhan Shrestha indicated no relevant financial relationships. Pravash Budhathoki indicated no relevant financial relationships. Yub Raj Sedhai indicated no relevant financial relationships. Oshan Shrestha indicated no relevant financial relationships. Sagun Karki indicated no relevant financial relationships. Niranjan Thapa indicated no relevant financial relationships. Chet Ranabhat indicated no relevant financial relationships. Paula Ferrada indicated no relevant financial relationships. Raju Bhandari indicated no relevant financial relationships.
Bhesh R. Karki, MD1, Dhan B. Shrestha, MD2, Pravash Budhathoki, MD3, Yub Raj Sedhai, MD4, Oshan Shrestha, MBBS5, Sagun Karki, MBBS5, Niranjan Thapa, MBBS5, Chet B. Ranabhat, MBBS6, Paula Ferrada, MD4, Raju Bhandari, MD7. P0921 - A Meta-Analysis on Antibiotic Treatment for Acute Uncomplicated Appendicitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.