Uses of Antibiotics Alone in Case of Uncomplicated Appendicitis

Abstract

The frequent abdominal surgical emergency is acute appendicitis with a significantly less lifelong risk. One of the most common surgeries manifested is an appendectomy, but with recent advances, non-operative management has evolved using antibiotics. In adult patients with simple appendicitis, we identified the role of surgical and non-surgical therapy. One of the most common surgeries manifested is an appendectomy, but with recent advances, non-operative management has evolved using antibiotics. In adults suffering from mild appendicitis, we identified the role of surgical and non-surgical therapy. The analysis indicated that the Antibiotics versus Primary Appendectomy in Children (APAC) did not establish non-inferiority of antibiotics vs. appendectomy with a pre-specified small margin. In contrast to the majority of appendectomies that are carried out laparoscopically, the surgeries were almost usually open. Appendectomies, both laparoscopic and open, are not the same procedure. Antibiotic therapy is effective in about 60% of cases of simple appendicitis. A surgery-only strategy would reduce antibiotic exposure, a factor to consider in these days of antimicrobial stewardship. Therefore, studies are being conducted on whether to shift alone on antibiotics or with appendectomy to have better results with fewer complications. Future studies should focus on appendicitis features and long-term unfavorable consequences, including antibiotic resistance or Clostridium difficile colitis, most responsive to antibiotics by utilizing laparoscopic procedures as controls. Using it along with appendectomy may change the outcome showing a better prognosis.

The Vermiform Appendix and Its Pathologies

“…Regarding adverse events, these were 4% in the antibiotic-treated group and 3% in the appendectomy group. The conclusion of the study reinforced what had been stated earlier [122,126,134], indicating that the use of antibiotics in the treatment of uncomplicated acute appendicitis (appendicitis without perforation, appendiceal abscess, or mass formation) may be an alternative to appendectomy [122,123,126,127,134]. At five years from the onset of symptoms, recurrence of acute appendicitis was reported in 39.1% of the patients treated with antibiotics alone [2,117,118].…”

“…None [119] Effectiveness and safety in preventing occurrence [119] Limitations: -Complications: postoperative bleeding, wound infection, intra-abdominal abscess, and paralytic ileus, with a rate of 8.7% [120,121] Antibiotic administration High [122] 5% during the one-year follow-up period [123] 2-14% for initial antibiotic treatment, during follow-up [124] 28.6% % after an average of 4.3 years of follow-up, especially when appendicoliths are present [125] 34.0% at 2 years, 35.2% at 3 years, 37.1% at 4 years, and 39.1% at 5 years [126] Avoiding surgical approach in most cases [122,123,126,127] Less pain, less analgesia [122] Low hospitalization rate [127] Effectiveness in about 60% of cases of simple appendicitis [123] Limitations: applies only to uncomplicated cases [128] Complications: perforation and pelvic sepsis [126], occurring in 8.1 per 100 participants, being higher for those with appendicoliths (20.2 per 100 participants) compared to those with no appendicoliths (3.7 per 100 participants) [127] Some cases (29%) need appendectomy after 90 days [127] Endoscopic retrograde appendicitis therapy 2.86% during the first six months of postoperative follow-up [129] 5 to 6.2% [130] Nonoperative and minimally invasive, safe, and effective endoscopic treatment [129,131] Limitations: applies to uncomplicated cases [131] Complications: increased risk of bowel cancer [132] The first report on the surgical treatment of acute appendicitis dates from 1736, when Claudius Amyand operated on an 11-year-old boy with a scrotal hernia (which is called Amyand hernia, with four subtypes; see further), who also had the appendix inflamed and perforated by a needle encrusted with a stone towards the head, located in the hernial sac. After a month of bed rest and following a strict regimen, the boy was considered recovered [116].…”

Apendicitis aguda: manejo quirúrgico vs antibiótico como opción de tratamiento

“…Yadao et al, (16) 2022 Se ha investigado la terapia no quirúrgica en adultos y niños para tratar la apendicitis aguda y complicada. El tratamiento no quirúrgico para la apendicitis no complicada es un enfoque viable y bien tolerado por algunos pacientes.…”

Surgical insights: Assessing acute appendicitis in a fifth‐wave COVID‐19 cluster—A retrospective cohort analysis

“…While the exclusion was necessary to maintain a focus on surgical cases, it raises questions about the potential impact of these alternative management approaches on the overall trends in acute appendicitis cases during the pandemic. A more comprehensive assessment that includes non-surgical management cases could provide a more holistic understanding of patient outcomes as demonstrated by Yadao et al 2 The study acknowledges that it covers only part of the COVID-19 fifth-wave pandemic. However, the COVID-19 pandemic's impact on healthcare systems, patient behaviour and clinical guidelines evolved over time.…”

“…The authors declare that they have no competing interests. Ahmed Gawash 1,2 David F. Lo MBS 1,2,3 1 Department of Medicine, Rowan University School of Osteopathic…”