title: Antibiotics alone versus appendectomy to treat uncomplicated acute appendicitis in adults: what do meta-analyses say?
abstract: BACKGROUND
  Primary appendectomy is the current standard of care for treating uncomplicated acute appendicitis, but interest in conservative treatment with antibiotics alone has been increasing in recent years. Clinical trials so far have shown controversial results.
  
  
  METHODS
  A series of meta-analyses were reviewed. Studies comparing surgery versus antibiotics alone for treating uncomplicated acute appendicitis in adults were included. Descriptive statistics and data on treatment effects were retrieved and summarized.
  
  
  RESULTS
  The conservative approach has a success rate of around 60 % and is associated with shorter pain duration, reduced analgesic medication, faster resolution of the inflammation process, lower expenses and quicker return to work. On the other hand, medical treatment leads to high (up to 20 %) readmission rates and more often requires surgery. An operative approach is associated with higher treatment success rates (>90 %) and very a low mortality rate.
  
  
  CONCLUSIONS
  Based on the current body of evidence, the use of antibiotics for primary treatment of uncomplicated acute appendicitis cannot be routinely recommended. Appendectomy remains the gold-standard treatment.
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil ; Telemedicine Service, Hospital Israelita Albert Einstein, Av. Albert Einstein, 2 andar, bloco D, São Paulo, CEP: 05651-901 Brazil.
authors.forename: Leonardo Lima
authors.initials: LL
authors.lastname: Rocha
authors.affiliation: Surgery Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Felipe Martin Bianco
authors.initials: FM
authors.lastname: Rossi
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Camila Menezes Souza
authors.initials: CM
authors.lastname: Pessoa
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Flavia Nunes Dias
authors.initials: FN
authors.lastname: Campos
authors.affiliation: Surgery Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Carlos Eduardo Fonseca
authors.initials: CE
authors.lastname: Pires
authors.affiliation: Telemedicine Service, Hospital Israelita Albert Einstein, Av. Albert Einstein, 2 andar, bloco D, São Paulo, CEP: 05651-901 Brazil ; Surgery Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Milton
authors.initials: M
authors.lastname: Steinman
keywords: Antibiotics; Appendectomy; Appendicitis; Conservative; Meta-analysis; Surgery