Lancet Gastroenterol Hepatol

Acute appendicitis: Meta-analysis compares antibiotics vs. surgery

March 25, 2025

Study details: This individual patient data meta-analysis pooled data from six randomized trials to compare the outcomes of antibiotic treatment vs. appendectomy in adults with image-confirmed acute appendicitis. The analysis aimed to provide a comprehensive evaluation of the efficacy and safety of both treatment modalities.

Results: The meta-analysis included six RCTs with 2,101 patients (39.5% women, 60.5% men) and found that antibiotic treatment for acute appendicitis is a safe alternative to surgery, with 5.4% of patients on antibiotics experiencing complications at 1 year compared with 8.3% who underwent appendectomy. However, patients with an appendicolith had higher complication rates with antibiotics (15.0% vs. 6.3%) and nearly half required surgery within a year.

Clinical impact: While antibiotics can be a viable initial treatment for acute appendicitis in adults, careful patient selection is crucial. Physicians should consider the potential for recurrence and the need for subsequent surgery when opting for antibiotic therapy. This approach may be particularly beneficial for patients with contraindications to surgery or those preferring a non-surgical option.

Source:

Scheijmans JCG, et al. (2025, March). Lancet Gastroenterol Hepatol. Antibiotic treatment versus appendicectomy for acute appendicitis in adults: an individual patient data meta-analysis. https://pubmed.ncbi.nlm.nih.gov/39827891/