Studies have investigated the management of uncomplicated appendicitis with antibiotics only compared with surgical appendectomy. Most studies have reported on small sample sizes, and have included only highly selected patients with no signs of sepsis, perforation, or abscess formation. In most of these studies, intravenous antibiotics were given for 48 to 72 hours followed by 7 to 10 days of oral antibiotics. Serial clinical examinations were performed every 6 to 12 hours while patients were being given intravenous antibiotics. Patients underwent surgery if any signs of sepsis, peritonitis, or shock developed during inpatient observation. Findings from these studies have not shown antibiotic-only therapy to be as effective as surgery for managing uncomplicated appendicitis, but they have shown that some patients can be managed successfully with antibiotics only. Several systematic reviews have concluded that although surgery is more effective than antibiotics at reducing treatment failure in uncomplicated appendicitis, the risk of complications is higher with surgery. However, the evidence base is generally weak and confounded by factors such as lack of consistency with results, diagnostic protocol, outcomes measured, and the type of surgical procedure performed. At this time, treatment with antibiotics only would not be recommended as a first choice for acute appendicitis. Nevertheless, some patients with uncomplicated appendicitis may benefit from primary antibiotic therapy. Further large trials are required.
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