The efficacy of antibiotic treatment versus surgical treatment of uncomplicated acute appendicitis: Systematic review and network meta-analysis of randomized controlled trial.

Abstract:

BACKGROUND:The efficacy of antibiotics in appendicitis remains controversial, and physicians are not confident in prescribing antibiotics as the first line treatment. This network meta-analysis was conducted to assess the efficacy and safety of individual antibiotics in uncomplicated appendicitis. METHODS:Randomized controlled trials (RCTs) were identified from MEDLINE and SCOPUS databases since inception to July 2017. STUDIES:Network meta-analysis was applied to estimate treatment effects and safety. Probability of being the best treatment was estimated using surface under the cumulative ranking curve (SUCRA). RESULTS:Among 9 RCTs meeting our inclusion criteria. A network meta-analysis indicated that those receiving antibiotics had about 12-32% lower chance of treatment success and lower risk of complication about 23-86%, especially Beta-lactamase than appendectomy. The overall appendicitis recurrence rate in the antibiotic group was about 18.2%. The SUCRA indicated that appendectomy was ranked first for treatment success and least complications, followed by Beta-lactamase. CONCLUSIONS:Appendectomy is still the most effective treatment in uncomplicated appendicitis but it carries complications. Beta-lactamase, might be an alternative treatment if there are any contraindications for operation.

journal_name

Am J Surg

authors

Poprom N,Numthavaj P,Wilasrusmee C,Rattanasiri S,Attia J,McEvoy M,Thakkinstian A

doi

10.1016/j.amjsurg.2018.10.009

subject

Has Abstract

pub_date

2019-07-01 00:00:00

pages

192-200

issue

1

eissn

0002-9610

issn

1879-1883

pii

S0002-9610(18)30954-1

journal_volume

218

pub_type

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