title: Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Although standard treatment typically consists of an early appendectomy, there has recently been an increase in the use of antibiotic therapy as primary treatment for acute appendicitis (AA). The aim of this analysis is to systematically evaluate the evidence available in relevant literature in order to compare the relative effectiveness of antibiotic therapy as a viable alternative to appendectomies in the treatment of AA.
  
  
  METHODS
  Literature was searched for randomized clinical trials (RCTs) comparing the efficacy of surgery versus antibiotic therapy. Differences in pooled odds ratios (OR) for outcomes within 95% confidence intervals (CI) were calculated.
  
  
  RESULTS
  Four RCTs were identified including 741 patients. Efficacy was significantly higher for surgery (OR = 6.01, 95% CI = 4.27-8.46). No differences were found in the numbers of perforated appendices (OR = 0.73, 95% CI = 0.29-1.84) and patients treated with antibiotics (OR = 0.04, 95% CI = 0.00-3.27). Complication rates were significantly higher for surgery (OR = 1.92, 95% CI = 1.30-2.85).
  
  
  CONCLUSIONS
  Although a nonsurgical approach in AA can reduce the complications rate, the lower efficacy prevents antibiotic treatment from being a viable alternative to surgery. Since only a small number of RCTs of poor methodological quality are available, well-designed RCTs are needed for further investigation.
authors.affiliation: Unit of General Surgery, Ospedali Riuniti, Bergamo, Italy. lansaloni @ ospedaliriuniti.bergamo.it
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Filippo
authors.initials: F
authors.lastname: Gazzotti
authors.forename: Eddi
authors.initials: E
authors.lastname: Pasqualini
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy; D001064:Appendicitis / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents