The current treatment for acute
appendicitis is an
appendectomy. Several studies have, however, assessed the efficacy of an
antibiotic for treating acute
appendicitis that is either uncomplicated or complicated by local
peritonitis. A meta-analysis in 2007 that collected the results of 44 prospective studies showed that
antibiotics were efficacious in 92.8% of cases of
appendicitis complicated by local
peritonitis, with percutaneous drainage of an
abscess when necessary. No predictive factor for failure was identified. The failure of
antibiotic treatment did not increase morbidity. Over time and on the whole, the recurrence rate was only 8.9%. The risk of
cancer of the appendix (1.5%) nonetheless led to the recommendation of an interval
appendectomy for adults. Four randomized controlled trials have compared
antibiotic treatment with an
appendectomy for the treatment of uncomplicated acute
appendicitis. The efficacy of the
antibiotic treatment ranged from 86 to 100% and the recurrence rate from 10.4 to 35%. These studies have had various methodological impediments; however, too few patients were included (40 and 80 patients), or only a clinical diagnosis was made before inclusion, or important protocol violations occurred, in particular for almost half the patient in the
antibiotic therapy group in the 2009 study. These problems prevent us from relying on these authors' findings.
Antibiotics have a role in the initial treatment of acute
appendicitis complicated by local
peritonitis. In uncomplicated acute
appendicitis, the methodological inadequacy of the currently available randomized trials makes it impossible to reach a definitive conclusion about the efficacy of
antibiotics.