Antibiotic Therapy for Appendicitis in Patients Aged ≥80 Years

Park, Hyoung-Chul; Kim, Min Jeong; Lee, Bong Hwa

doi:10.1016/j.amjmed.2014.01.018

Cited by 14 publications

(17 citation statements)

References 5 publications

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“…There is one prospective, noncomparative trial of 26 participants 80 years and older managed conservatively. 34 Excluding this study, among adult trials with available data, the range of maximum ages was 60 to 79 years and mean or median age was 26 to 38 years.…”

Section: Resultsmentioning

confidence: 99%

Methods of conservative antibiotic treatment of acute uncomplicated appendicitis: A systematic review

Talan

Saltzman

DeUgarte

et al. 2019

J Trauma Acute Care Surg

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BACKGROUND Meta-analyses and a recent guideline acknowledge that conservative management of uncomplicated appendicitis with antibiotics can be successful for patients who wish to avoid surgery. However, guidance as to specific management does not exist. METHODS PUBMED and EMBASE search of trials describing methods of conservative treatment was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS Thirty-four studies involving 2,944 antibiotic-treated participants were identified. The greatest experience with conservative treatment is in persons 5 to 50 years of age. In most trials, imaging was used to confirm localized appendicitis without evidence of abscess, phlegmon, or tumor. Antibiotics regimens were generally consistent with intra-abdominal infection treatment guidelines and used for a total of 7 to 10 days. Approaches ranged from 3-day hospitalization on parenteral agents to same-day hospital or ED discharge of stable patients with outpatient oral antibiotics. Minimum time allowed before response was evaluated varied from 8 to 72 hours. Although pain was a common criterion for nonresponse and appendectomy, analgesic regimens were poorly described. Trials differed in use of other response indicators, that is, white blood cell count, C-reactive protein, and reimaging. Diet ranged from restriction for 48 hours to as tolerated. Initial response rates were generally greater than 90% and most participants improved by 24 to 48 hours, with no related severe sepsis or deaths. In most studies, appendectomy was recommended for recurrence; however, in several, patients had antibiotic retreatment with success. CONCLUSION While further investigation of conservative treatment is ongoing, patients considering this approach should be advised and managed according to study methods and related guidelines to promote informed shared decision-making and optimize their chance of similar outcomes as described in published trials. Future studies that address biases associated with enrollment and response evaluation, employ best-practice pain control and antibiotic selection, better define cancer risk, and explore longer time thresholds for response, minimized diet restriction and hospital stays, and antibiotic re-treatment will further our understanding of the potential effectiveness of conservative management. LEVEL OF EVIDENCE Systematic review, level II.

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Section: Resultsmentioning

confidence: 99%

Methods of conservative antibiotic treatment of acute uncomplicated appendicitis: A systematic review

Talan

Saltzman

DeUgarte

et al. 2019

J Trauma Acute Care Surg

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“…In a small retrospective study on patients older than 80 years old with non-complicated appendicitis, Park et al [61] showed that NOM is safe and effective in selected patients, with a NOM success rate higher than 70%.…”

Section: What Is the Optimum Pathway For Imaging Inmentioning

confidence: 99%

The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition)

et al. 2020

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The epidemiology and the outcomes of acute appendicitis in elderly patients are very different from the younger population. Elderly patients with acute appendicitis showed higher mortality, higher perforation rate, lower diagnostic accuracy, longer delay from symptoms onset and admission, higher postoperative complication rate and higher risk of colonic and appendiceal cancer. The aim of the present work was to investigate age-related factors that could influence a different approach, compared to the 2016 WSES Jerusalem guidelines on general population, in terms of diagnosis and management of elderly patient with acute appendicitis. During the XXIX National Congress of the Italian Society of Surgical Pathophysiology (SIFIPAC) held in Cesena (Italy) in May 2019, in collaboration with the Italian Society of Geriatric Surgery (SICG), the World Society of Emergency Surgery (WSES) and the Italian Society of Emergency Medicine (SIMEU), a panel of experts participated to a Consensus Conference where eight panelists presented a number of statements, which were developed for each of the four topics about diagnosis and management of acute appendicitis in elderly patients, formulated according to the GRADE system. The statements were then voted, eventually modified and finally approved by the participants to the Consensus Conference. The current paper is reporting the definitive guidelines statements on each of the following topics: diagnosis, non-operative management, operative management and antibiotic therapy.

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“…However, non-operative management is well tolerated and efficacious in select populations, especially in children[ 125 - 127 ]. Some patients who initially receive conservative treatments do not require surgical intervention[ 13 , 17 , 107 , 120 , 128 ], and AA should no longer be regarded as an indication for interval/delayed appendectomy[ 13 , 17 , 107 , 120 , 128 , 129 ]. Routine interval/delayed appendectomy benefits less than 20% of patients[ 14 ].…”

Section: Conservative Treatment Alonementioning

confidence: 99%

“…Some situations of patients are especially listed in surgical indications, such as older people, pregnancy, and negative appendectomy[ 1 , 48 , 129 ]. Although LA in pregnant women has been already reported, fetal loss and negative appendectomy should be avoided in this population[ 132 , 133 ].…”

Section: Specific Situationsmentioning

confidence: 99%

Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

Hori¹,

Machimoto²,

Kadokawa³

et al. 2017

WJG

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Acute appendicitis (AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy (LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Non-operative management of AA may be tolerated only in children. Postoperative complications increase according to the patient’s factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon’s skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner (i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.

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Antibiotic Therapy for Appendicitis in Patients Aged ≥80 Years

Cited by 14 publications

References 5 publications

Methods of conservative antibiotic treatment of acute uncomplicated appendicitis: A systematic review

Methods of conservative antibiotic treatment of acute uncomplicated appendicitis: A systematic review

The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition)

Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

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