ANTIBIOTICS VS APPENDECTOMY FOR UNCOMPLICATED APPENDICITIS
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Keywords
Uncomplicated appendicitis, antibiotics, appendectomy, treatment outcomes.
Abstract
Background: Medical professionals traditionally treat uncomplicated appendicitis through surgical appendectomy since the condition manifests as appendix inflammation without perforation, abscess, or generalized peritonitis. The CODA trial and other recent scientific studies indicate that antibiotic treatment could offer a risk-free procedure for dealing with this condition. Researchers determine the performance and results between antibiotic medication and appendectomy treatments for uncomplicated appendicitis patients.
Objectives: to evaluate clinical results, recurrence rates, and recovery times for patients with uncomplicated appendicitis who receive antibiotic treatments instead of appendectomy surgery.
Study design: A retrospective cohort study.
Place and duration of study. Department of Surgery QHAMC, Nowshera Medical college ,Nowshera from jan 2021 to june 2021
Methods: The study analyzed 150 patients diagnosed with uncomplicated appendicitis through retrospective cohort research. Medical staff placed 75 patients into the antibiotic treatment group, while the other 75 received surgical appendix removal. The study examined clinical results, patient recovery times, and return of symptoms and treatment-related issues. Research analysts computed group significance using the chi-square and t-tests and calculated mean Age and standard deviation with p-values.
Results: The study evaluated 150 patients with an average age of 32.4 years and a standard deviation of 10.2 years. Among the patients, no considerable age gap existed between groups receiving antibiotics and those undergoing appendectomy (p = 0.48). Among patients who received antibiotics, there was a 25% (19 out of 75) recurrence rate of appendicitis that required surgery within one year. Every patient in the appendectomy group remained free from reactivation of their condition. People who received antibiotics needed only 2.3 days ± 1.1 days of hospital care, while those undergoing appendectomy required 3.5 days ± 1.4 days (p < 0.01). Medical costs proved higher in the antibiotic group since patients needed extra treatments after their symptoms returned. Clinical outcomes revealed infection and adverse side effect complications at 7% for antibiotic patients versus 10% for patients who received appendectomy procedures (p = 0.62).
Conclusion: Uncomplicated appendicitis benefits from antibiotic treatment combined with appendectomy. Antibiotic treatment involves less invasive procedures and shorter recovery time, although it requires repeated cases of infection. Patients require appendectomy surgery, which has proven effective since recurrence occurs rarely. Medical decisions should be made with patients to select treatments that satisfy their particular requirements.
References
2. CODA Collaborative. Antibiotics versus appendectomy for acute appendicitis—longer-term outcomes. New England Journal of Medicine. 2021 Dec 16;385(25):2395-7.
3. Herrod PJ, Kwok AT, Lobo DN. Randomized clinical trials comparing antibiotic therapy with appendicectomy for uncomplicated acute appendicitis: meta-analysis. BJS open. 2022 Aug 1;6(4):zrac100.
4. Sajjad MN, Naumeri F, Hina S. Nonoperative treatment versus appendectomy for acute uncomplicated appendicitis: a randomized controlled trial. Pakistan Journal of Medical Sciences. 2021 Sep;37(5):1276.
5. Talan DA, Di Saverio S. Treatment of acute uncomplicated appendicitis. New England Journal of Medicine. 2021 Sep 16;385(12):1116-23.
6. St Peter SD, Noel-MacDonnell JR, Hall NJ, Eaton S, Suominen JS, Wester T, Svensson JF, Almström M, Muenks EP, Beaudin M, Piché N. Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children: an open-label, international, multicentre, randomized, non-inferiority trial. The Lancet. 2025 Jan 18;405(10474):233-40.
7. de Almeida Leite RM, Seo DJ, Gomez-Eslava B, Hossain S, Lesegretain A, de Souza AV, Bay CP, Zilberstein B, Marchi E, Machado RB, Barchi LC. Nonoperative vs operative management of uncomplicated acute appendicitis: a systematic review and meta-analysis. JAMA surgery. 2022 Sep 1;157(9):828-34.
8. Pata F, Nardo B, Ielpo B, Di Martino M, Murzi V, Di Saverio S, Yang B, Ortenzi M, Pisanu A, Pellino G, Podda M. Endoscopic retrograde appendicitis therapy versus appendectomy or antibiotics in the modern approach to uncomplicated acute appendicitis: A systematic review and meta-analysis. Surgery. 2023 Dec 1;174(6):1292-301.
9. Doleman B, Fonnes S, Lund JN, Boyd-Carson H, Javanmard-Emamghissi H, Moug S, Hollyman M, Tierney G, Tou S, Williams JP. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database of Systematic Reviews. 2024(4).
10. Zagales I, Sauder M, Selvakumar S, Spardy J, Santos RG, Cruz J, Bilski T, Elkbuli A. Comparing outcomes of appendectomy versus nonoperative antibiotic therapy for acute appendicitis: a systematic review and meta-analysis of randomized clinical trials. The American Surgeon™. 2023 Jun;89(6):2644-55.
11. O’Leary DP, Walsh SM, Bolger J, Baban C, Humphreys H, O’Grady S, Hegarty A, Lee AM, Sheehan M, Alderson J, Dunne R. A randomized clinical trial evaluating the efficacy and quality of life of antibiotic-only treatment of acute uncomplicated appendicitis: results of the COMMA trial.
12. Podda M, Poillucci G, Pacella D, Mortola L, Canfora A, Aresu S, Pisano M, Erdas E, Pisanu A, Cillara N. Appendectomy versus conservative treatment with antibiotics for patients with uncomplicated acute appendicitis: a propensity score-matched analysis of patient-centered outcomes (the ACTUAL prospective multicenter trial). International Journal of Colorectal Disease. 2021 Mar;36:589-98.
13. Scheijmans JC, Haijanen J, Flum DR, Bom WJ, Davidson GH, Vons C, Hill AD, Ansaloni L, Talan DA, van Dijk ST, Monsell SE. Antibiotic treatment versus appendicectomy for acute appendicitis in adults: an individual patient data meta-analysis. The Lancet Gastroenterology & Hepatology. 2025 Mar 1;10(3):222-33.
14. Mosuka EM, Thilakarathne KN, Mansuri NM, Mann NK, Rizwan S, Mohamed AE, Elshafey AE, Khadka A, Mohammed L. A systematic review comparing nonoperative management to appendectomy for uncomplicated appendicitis in children. Cureus. 2021 Oct 19;13(10).
15. Köhler F, Hendricks A, Kastner C, Müller S, Boerner K, Wagner JC, Lock JF, Wiegering A. Laparoscopic appendectomy versus antibiotic treatment for acute appendicitis—a systematic review. International journal of colorectal disease. 2021 Oct;36:2283-6.
16. Moris D, Paulson EK, Pappas TN. Diagnosis and management of acute appendicitis in adults: a review. Jama. 2021 Dec 14;326(22):2299-311.
17. Parsons C, Shapiro NI, Cooper R, Richter A, Morris A, Wolfe B, Yealy DM, Ballman K, O’Connor K, Owens O, Diflo T. Patient factors associated with appendectomy within 30 days of initiating antibiotic treatment for appendicitis. JAMA surgery. 2022 Mar 1;157(3):e216900-.
18. Javanmard-Emamghissi H, Hollyman M, Boyd-Carson H, Doleman B, Adiamah A, Lund JN, Moler-Zapata S, Grieve R, Moug SJ, Tierney GM. Antibiotics as a first-line alternative to appendicectomy in adult appendicitis: 90-day follow-up from a prospective, multicentre cohort study. British Journal of Surgery. 2021 Nov 1;108(11):1351-9.
19. Ali MT, Azhar M, Memon ML, Asif M. Antibiotics Versus Appendectomy for Acute Appendicitis. Pakistan Journal of Medical & Health Sciences. 2022 Oct 27;16(09):350-.
20. Emile SH, Sakr A, Shalaby M, Elfeki H. Efficacy and safety of nonoperative management of uncomplicated acute appendicitis compared to appendectomy: an umbrella review of systematic reviews and meta‐analyses. World Journal of Surgery. 2022 May;46(5):1022-38.
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Kamran Ahmad
Associate Professor Department of Surgery QHAMC, Nowshera Medical college ,Nowshera
Fazal Ghani
Associate Professor Department of Surgery QHAMC, Nowshera Medical college ,Nowshera
Kamran Hakeem Khan
Associate Professor Department of Surgery QHAMC, Nowshera Medical college ,Nowshera
Shafiq Ur Rahman
Consultant Department of Surgery QHAMC,Nowshera Medical college ,Nowshera
Khalil Ur Rehman
Consultant Shaheed Mohtrama Benazir Bhutto institute of trauma Karachi.
Aurangzeb Shaikh
Head Department of Ophthalmology-FRPMC Faisal Base Karachi