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Antibiotic Treatment Less Effective in Acute Appendicitis

Emergency appendectomy should still be considered the gold standard treatment

FRIDAY, May 6 (HealthDay News) -- Treatment of acute uncomplicated appendicitis with amoxicillin and clavulanic acid is not as effective as emergency appendectomy, according to a study published online May 7 in The Lancet.

Corinne Vons, M.D., from the Hôpital Antoine Béclère in Clamart, France, and colleagues compared the efficacy of amoxicillin plus clavulanic acid with emergency appendectomy for treatment of uncomplicated acute appendicitis in patients aged 18 to 68 years. Of 239 participants diagnosed by computed tomography (CT) who completed the intervention, 120 were randomized to receive antibiotic amoxicillin plus clavulanic acid (3 g per day) for eight to 15 days, and 119 received emergency appendectomy. These patients were included in intent-to-treat analysis. Occurrence of postintervention peritonitis within 30 days of treatment initiation was the primary study end point.

The investigators found that patients in the antibiotic group had significantly more frequent 30-day postintervention peritonitis than those in the appendectomy group (treatment difference, 5.8). In the intent-to-treat appendectomy group, despite a CT-scan assessment, 18 percent of patients unexpectedly developed complicated appendicitis with peritonitis at surgery. In the intent-to-treat antibiotic group, 12 percent underwent an appendectomy during the first 30 days. In this group, of the 102 participants who could be followed up to one year, 30 underwent appendectomy between one month and one year, 26 of whom had acute appendicitis (recurrence rate 26 percent).

"Our results suggest that emergency [appendectomy] remains the gold standard for treatment of acute uncomplicated appendicitis," the authors write.

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