Long‐Term Results Following Antibiotic Treatment of Acute Appendicitis in Adults

Abstract

BackgroundAntibiotic treatment of acute appendicitis has gained interest and inquiries. Reports have demonstrated both safety and high resolution of symptoms and inflammation following antibiotic treatment of appendicitis, but information on long-term results is required. Our present aim was therefore to evaluate long-term recurrence rate of initial antibiotics-alone treatment for suspected acute appendicitis.MethodsPatients with favourable response to antibiotics in earlier randomized (RCT, n = 97) and population-based (PBT, n = 342) studies as well as subsequently treated non-randomized (Non-R, n = 271) patients are evaluated for long-term risk to relapse demanding surgical appendectomy; altogether 710 patients.ResultsClinical characteristics among randomized and non-randomized patients were similar without any statistical difference according to abdominal symptoms and degree of systemic inflammation (CRP, WCC) when antibiotic treatment started. Females and males showed the same results. The median follow-up time was 2162 days (5.92 years), and the range across highest and lowest follow-up was 3495 days (range 2–3497) for the entire group, without significant differences among subgroups (RCT, PBT, Non-R). The cumulative probability for relapse of appendicitis demanding appendectomy was: 0.09, 0.12, 0.12 and 0.13 at 1-, 2-, 3- and 5-year follow-up, with a probability of 0.86 ± 0.013 without appendectomy after 8 years. This may imply an overall benefit of 60–70% by antibiotics during expected 10-year follow-up accounting for initial treatment failures at 10–23% in our published reports.ConclusionAntibiotic treatment is safe and effective as a first-line therapy in unselected adults with acute appendicitis with a risk around 15% for long-term relapse following favourable initial treatment response.

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

“…Our study did not look at patients undergoing interval appendectomy. This may introduce bias, as those undergoing antibiotic treatment will have a recurrence rate of between 15% and 40% and may re‐present with recurrent appendicitis . Similarly, antibiotic conservative management and non‐antibiotic conservative management of uncomplicated appendicitis may result in treatment failure; recurrent appendicitis occurs in up to 35%.…”

“…This may introduce bias, as those undergoing antibiotic treatment will have a recurrence rate of between 15% and 40% and may re-present with recurrent appendicitis. 71 Similarly, antibiotic conservative management and non-antibiotic conservative management of uncomplicated appendicitis may result in treatment failure; recurrent appendicitis occurs in up to 35%. Park's recent randomized trial of non-operative management, including an arm without antibiotic therapy, is interesting but this patient group was outside the scope of this current meta-analysis (which only focused on patients undergoing appendectomy).…”

Clinical Management of Appendicitis

“…However, follow-up periods in these studies mostly covered only 1 year. Long-term follow-up from non-randomized trials and observational studies, lasting up to 7 years, does not demonstrate higher rates of recurrence [37]. The recently published NOTA study demonstrated a success rate of 83% for NOM after a 2-year follow-up [38].…”

Endoscopic retrograde appendicitis techniques for the treatment of patients with acute appendicitis

“…▶ alone showed that the incidence of recurrent appendicitis ranged from 15 to 25 % [15,16]. However, in 2 recent studies using ERAT for acute appendicitis, the incidence of recurrent abdominal pain ranged from 6.2 to 15.0 % during a follow-up period of at least 1 year [9,12].…”