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.
Highlights
Antibiotic treatment of acute appendicitis as alternative to surgical appendectomy is a well-recognized possibility, with favourable response rates of 0.77–0.91 according to randomized and consecutively evaluated patients [1,2,3,4,5,6]
Clinical 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
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
Summary
Antibiotic treatment of acute appendicitis as alternative to surgical appendectomy is a well-recognized possibility, with favourable response rates of 0.77–0.91 according to randomized and consecutively evaluated patients [1,2,3,4,5,6]. It is still a controversy to what extent antibiotic treatment should be offered systematically as a first-line therapy [7, 8] It has even been doubted whether antibiotics offers significant resolution of inflamed appendices [9]. This uncertainty is probably in part dependent on that longterm results are essentially lacking in the literature, satisfying acute and long-term outcomes are reported in both adults [3] and children [10, 11] with uncomplicated appendicitis. Antibiotic 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 to evaluate long-term recurrence rate of initial antibiotics-alone treatment for suspected acute appendicitis
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