Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial

Vons, C.; Barry, Caroline; Maître, Sophie; Pautrat, Karine; Leconte, Mahaut; Costaglioli, Bruno; Karoui, Mehdi; Alvès, Arnaud; Dousset, B.; Valleur, Patrice; Falissard, Bruno; Franco, Dominique

doi:10.1016/s0140-6736(11)60410-8

Cited by 562 publications

(642 citation statements)

References 22 publications

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“…The philosopher of science John Worrall commented, after listing several medical treatments, including appendectomy for acute appendicitis, "no RCT has ever been performed on any of these treatments and none presumably ever will." 76 Yet there are now 4 RCTs of appendectomy versus antibiotics, [77][78][79][80] which suggests that there may be a subset of patients who can be spared surgery. Another example is precision oncology.…”

Section: Discussionmentioning

confidence: 99%

Most medical practices are not parachutes: a citation analysis of practices felt by biomedical authors to be analogous to parachutes

Hayes¹,

Kaestner

Mailankody

et al. 2018

CMAJ Open

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Background:In a 2003 paper in BMJ, the authors made the tongue-in-cheek observation that there are no randomized controlled trials (RCTs) of parachutes. This paper has been widely read, cited and used to argue that RCTs are impractical or unnecessary for some medical practices. We performed a study to identify and evaluate claims that a medical practice is akin to a parachute. Methods:Using Google Scholar, we identified all citations to the 2003 paper. We searched for claims that a specific practice was akin to a parachute. For each practice, we identified the desired outcome of the practice, and searched Google Scholar and ClinicalTrials.gov for RCTs that were conducted, ongoing, halted, planned or unpublished.Results: Of 822 articles citing the original paper, 35 (4.1%) argued that a medical practice was akin to a parachute. Eighteen of the 35 (51%) concerned mortality or live birth, and 17 (49%) concerned a lesser outcome. For 22 practices (63%), we identified 1 or more RCTs: in 6 cases (27%), the trials showed a statistically significant benefit of the practice; in 5 (23%), the trials rejected the practice; in 5 (23%), the trials had mixed results; in 2 (9%), the trials were halted; and in 4 (18%), the trials were ongoing. Effect size was calculated for 5 of the 6 practices for which RCTs gave positive results, and the absolute risk reduction ranged from 11% to 30.8%, corresponding to a number needed to treat of 3-9.Interpretation: Although there is widespread interest regarding the BMJ paper arguing that randomized trials are not necessary for practices of clear benefit, there are few analogies in medicine. Most parachute analogies in medicine are inappropriate, incorrect or misused. Abstract Research OPEN Research E32CMAJ OPEN, 6(1)

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Section: Discussionmentioning

confidence: 99%

Most medical practices are not parachutes: a citation analysis of practices felt by biomedical authors to be analogous to parachutes

Hayes¹,

Kaestner

Mailankody

et al. 2018

CMAJ Open

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“…Therefore, it is an acceptable option in cases of uncomplicated appendicitis. [26,27] Once surgical treatment has been selected, options include open or laparoscopic appendectomy. Abe et al recently reported that complicated appendicitis and diffuse peritonitis were risk factors of conversion to open during laparoscopic appendectomy.…”

Section: Discussionmentioning

confidence: 99%

Neutrophil - Lymphocyte Ratio and Mean Platelet Volume Can Be a Predictor for the Severity of Acute Appendicitis

Yardimci

Uğurlu

Coşkun

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…Five prospective RCTs [27][28][29][30][31] with a total of 1430 patients met the selection criteria and were eligible for inclusion. The number of patients, per protocol, allocated to the antibiotic group was 644, while 786 patients comprised the surgery group.…”

Section: Resultsmentioning

confidence: 99%

A Meta-Analysis of Antibiotics Versus Surgery for the Treatment of Acute Appendicitis

Madanat¹,

Shaban²,

Naghawi³

et al. 2017

BIO

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Abstract:Appendectomy is the mainstay of treatment for acute appendicitis. Considering the complications of surgery, antibiotic treatment has also been gaining increasing interest in cases of acute appendicitis. This study aimed to compare the efficacy of antibiotics to surgery for acute uncomplicated appendicitis. The PubMed, Medline, Medscape and Cochrane databases were searched for studies comparing antibiotics versus surgery. The six outcome measures identified were thirty-day post-therapeutic peritonitis, length of hospital stay, prevalence of total complications, prevalence of normal appendix, prevalence of mean duration of pain and duration of disability. Five prospective RCTs with a total of 1430 patients (644 in the antibiotic group and 786 in the surgical group) were included in this study. Antibiotic treatment had a success rate of 75.3%. Regarding overall mean duration of disability, the antibiotic group had a significantly shorter duration of disability than that of the surgery group (P < 0.05). The total number of complications in the antibiotic group was 3.6% while that of the surgical group was 11.6%. The overall difference for mean duration of pain, and length of hospital stay between antibiotic therapy and surgery were not found to be statistically significant (P > 0.05). Although the conservative approach has a success rate lower than appendectomy, it is a possible alternative in certain clinical scenarios. Appendectomy remains the mainstay treatment for acute appendicitis. However, additional studies clarifying the certain etiologies of appendicitis that are responsive to antibiotic treatment are needed to further support its use.

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Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial

Cited by 562 publications

References 22 publications

Most medical practices are not parachutes: a citation analysis of practices felt by biomedical authors to be analogous to parachutes

Most medical practices are not parachutes: a citation analysis of practices felt by biomedical authors to be analogous to parachutes

Neutrophil - Lymphocyte Ratio and Mean Platelet Volume Can Be a Predictor for the Severity of Acute Appendicitis

A Meta-Analysis of Antibiotics Versus Surgery for the Treatment of Acute Appendicitis

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