Comparative effectiveness of surgery versus antibiotics in acute appendicitis: a systematic review

Aim: To review outcomes of surgical and antibiotic management of acute appendicitis. Methods: 11 prospective studies comparing surgical versus antibiotic management of acute appendicitis over a 21-year period were reviewed. Results: Antibiotic management is successful in most cases of uncomplicated acute appendicitis. The need for crossover in management and recurrent appendicitis were low among all studies. For those patients who ultimately required surgery, no increased complications were observed. Conclusion: The decision to use antibiotics to treat acute appendicitis should be held to the same standards of diagnostic rigor as surgical management. Antibiotics may be safely recommended in patients with high surgical risk, such as the elderly or those with multiple comorbidities.