Abstract

ANTIBIOTICS TREATMENT VERSUS SURGICAL TREATMENT FOR MANAGEMENT OF UNCOMPLICATED APPENDICITIS: A METAANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Norah Abdulaziz Bin Aydan*, Abdulaziz Faisal Wanes Alrubayyi, Abdulmohesin Khalid Bin Hussein, Ahmad Sameer Alrefaie, Zahra abdulwahed Alshammasi,
Abdullah Khalid Alomar, Mohammed Saeed Bafail, Anmar Khalid Alkindy, Ahmed Ali Almeshari, Ibrahim Nasser Alghannam

Abstract

Background & Purpose: Till lately, the best treatment alternative considered for patients with acute appendicitis changed into surgical treatment. Now, six randomized researches show that non-operative management is a secure and possible therapeutic choice for sufferers with uncomplicated appendicitis. The Aim of this work is to provide cumulative data about the efficacy and safety of Antibiotics Treatment (AT) versus Surgical Treatment (ST) for management of uncomplicated appendicitis. Methods: A systematic search was performed of PubMed, Cochrane library Ovid, Scopus & Google scholar to identify general surgery RCTs, clinical trials, and comparative studies, which studied the outcome of AT group versus ST group of uncomplicated appendicitis patients. A meta-analysis was done using fixed and randomeffect methods. The primary outcome of interest was success rate (treatment effectiveness). Secondary outcome was complications rate. We calculated efficacy (favorable outcome), for each group through success rate. We also calculated safety (adverse outcome), for each group through complications rate (including recurrence). Results: A total of 6 studies were identified involving 1985 patients, with 1082 patients in AT group, and 903 patients in ST group. Regarding efficacy outcome measure, the fixed-effects model of the meta-analysis study showed highly significant decrease in success rate in AT group compared to ST group (p < 0.01). Regarding safety outcome measures, the random-effects model of the meta-analysis study showed significant decrease in complications rate in AT group compared to ST group (p = 0.017). Conclusion: To conclude, despite the fact that antibiotics may also prevent a few patients from appendectomies, surgical procedure represents the definitive, one-time simplest treatment with a known risk profile.

Keywords: Antibiotics, Surgery, Uncomplicated Appendicitis.