Outcomes of Antibiotics as Primary Therapy in Uncomplicated Acute Appendicitis at PUMHS Nawabshah (original) (raw)
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Science Midwifery
The purpose of this research to compare the effectiveness of appendectomy by administering non-operative management in the form of antibiotics in acute appendicitis patients. The research method used descriptive qualitative through the Literature Review (LR) approach. The data source used a secondary source. Data analysis technique selects literature based on title, year, and indexed articles, then reviews articles that match the subject matter. the articles from those journals are compared to find the differences and similarities. A literature review of four PubMed, DOAJ, Cochrane, and Google Scholar databases published in the last five years, i.e. from 2018-2022. Twelve pieces of literature were obtained and reported the advantages and disadvantages of each procedure. Apshortextomy keeps the gold standard with a lower risk of recurrence and severity and a higher treatment success rate. Appendectomy is also required for appendicitis cases with complications. However, antibiotic t...
World Journal of Surgery, 2007
Background: Appendectomy has been the treatment for acute appendicitis for over 120 years. Antibiotic treatment has occasionally been used in small uncontrolled studies, instead of operation, but this alternative has never before been tried in a multicenter randomized trial. Patients and Methods: Male patients, 18-50 years of age, admitted to six different hospitals in Sweden between 1996 and 1999 were enrolled in the study. No women were enrolled by decision of the local ethics committee. If appendectomy was planned, patients were asked to participate, and those who agreed were randomized either to surgery or to antibiotic therapy. Patients randomized to surgery were operated on with open surgery or laparoscopically. Those randomized to antibiotic therapy were treated intravenously for 2 days, followed by oral treatment for 10 days. If symptoms did not resolve within 24 hours, an appendectomy was performed. Participants were monitored at the end of 1 week, 6 weeks, and 1 year. Results: During the study period 252 men participated, 124 in the surgery group and 128 in the antibiotic group. The frequency of appendicitis was 97% in the surgery group and 5% had a perforated appendix. The complication rate was 14% in the surgery group. In the antibiotic group 86% improved without surgery; 18 patients were operated on within 24 hours, and the diagnosis of acute appendicitis was confirmed in all but one patient, and he was suffering from terminal ileitis. There were seven patients (5%) with a perforated appendix in this group. The rate of recurrence of symptoms of appendicitis among the 111 patients treated with antibiotics was 14% during the 1year follow-up. Conclusions: Acute nonperforated appendicitis can be treated successfully with antibiotics. However, there is a risk of recurrence in cases of acute appendicitis, and this risk should be compared with the risk of complications after appendectomy.
Background: Acute appendicitis is the most common surgical emergency in young adults. A delayed presentation of a patient with uncomplicated appendicitis may progress to a complicated appendicitis (appendicular phlegmon, gangrene, perforation abscess, localized or generalized peritonitis). Emergency Surgery is the standard of care. Material and Methods: We have prospectively analysed 167 patients with proper informed consent to participate in the study, having satisfied our inclusion criteria. 86 patients had uncomplicated appendicitis and 81 had complicated appendicitis. The presentation and surgical outcomes of both these clinical entities were compared and the feasibility of a rational dose of single day course of antibiotics has been evaluated statistically. Results and Analysis: Of 167 patients the majority of patients were within the age group of 11-20, 65(38.9%), with a slight female predominance. Of the 81 patients with complicated appendicitis 45.7% presented with a Phlegmon .Mean days of symptoms of patients in complicated appendicitis, was 3.1852 ?.8531 days compared to 1.5698 ?.4980 days uncomplicated Most of the complicated cases had fever during presentation. Mean operative time (40.6914 ?10.3388 mins) , incidence of wound infection (22%) , ileus (29.6%) is more in complicated appendicitis. There was one case of Faecal fistula. The mean duration of antibiotics is more in complicated appendicitis 9.1975 ?3.4728 days versus 3.5116 ?2.9773 days leading to prolonged stay (5.7160 ?2.7894 days) in complicated cases. Complicated appendicitis patients have more morbidity (ClavienDindo score >1).50 patients out of 85 patients (58%) with uncomplicated appendicitis were given a rationally justified, single day dose of antibiotics, without any complications. Hence the prognoses of such patients were better leading to minimal morbidity.
The Professional Medical Journal
Objective: To determine the frequency of conservatively managed patients of acute appendicitis by using new (Muzammil-Mudassar appendicitis severity score) scoring system. Study Design: Cross Sectional Observational study. Setting: Government Teaching Hospital, Shahdara. Period: October 2021 to April 2022. Material & Methods: 267 patients diagnosed with acute appendicitis by ALVARADO score were enrolled. New appendicitis severity score was devised by searching online literature. A cut off value of 11 was defined after conducting a pilot study. Patients having score of < 11 were eligible for conservative management. All patients undergoing conservative treatment were receiving nothing per oral and given intravenous antibiotics (ciprofloxacin and metronidazole), intravenous fluids and infusion Paracetamol three times a day for at least 24-48 hours. Surgery was done in failed or unsatisfied cases. Weekly follow-up for first two weeks and then monthly for three months was done. Resul...
Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis
JAMA, 2015
IMPORTANCE An increasing amount of evidence supports the use of antibiotics instead of surgery for treating patients with uncomplicated acute appendicitis. OBJECTIVE To compare antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis confirmed by computed tomography (CT). DESIGN, SETTING, AND PARTICIPANTS The Appendicitis Acuta (APPAC) multicenter, open-label, noninferiority randomized clinical trial was conducted from November 2009 until June 2012 in Finland. The trial enrolled 530 patients aged 18 to 60 years with uncomplicated acute appendicitis confirmed by a CT scan. Patients were randomly assigned to early appendectomy or antibiotic treatment with a 1-year follow-up period. INTERVENTIONS Patients randomized to antibiotic therapy received intravenous ertapenem (1 g/d) for 3 days followed by 7 days of oral levofloxacin (500 mg once daily) and metronidazole (500 mg 3 times per day). Patients randomized to the surgical treatment group were assigned to undergo standard open appendectomy. MAIN OUTCOMES AND MEASURES The primary end point for the surgical intervention was the successful completion of an appendectomy. The primary end point for antibiotic-treated patients was discharge from the hospital without the need for surgery and no recurrent appendicitis during a 1-year follow-up period. RESULTS There were 273 patients in the surgical group and 257 in the antibiotic group. Of 273 patients in the surgical group, all but 1 underwent successful appendectomy, resulting in a success rate of 99.6% (95% CI, 98.0% to 100.0%). In the antibiotic group, 70 patients (27.3%; 95% CI, 22.0% to 33.2%) underwent appendectomy within 1 year of initial presentation for appendicitis. Of the 256 patients available for follow-up in the antibiotic group, 186 (72.7%; 95% CI, 66.8% to 78.0%) did not require surgery. The intention-to-treat analysis yielded a difference in treatment efficacy between groups of −27.0% (95% CI, −31.6% to ϱ) (P = .89). Given the prespecified noninferiority margin of 24%, we were unable to demonstrate noninferiority of antibiotic treatment relative to surgery. Of the 70 patients randomized to antibiotic treatment who subsequently underwent appendectomy, 58 (82.9%; 95% CI, 72.0% to 90.8%) had uncomplicated appendicitis, 7 (10.0%; 95% CI, 4.1% to 19.5%) had complicated acute appendicitis, and 5 (7.1%; 95% CI, 2.4% to 15.9%) did not have appendicitis but received appendectomy for suspected recurrence. There were no intra-abdominal abscesses or other major complications associated with delayed appendectomy in patients randomized to antibiotic treatment. CONCLUSIONS AND RELEVANCE Among patients with CT-proven, uncomplicated appendicitis, antibiotic treatment did not meet the prespecified criterion for noninferiority compared with appendectomy. Most patients randomized to antibiotic treatment for uncomplicated appendicitis did not require appendectomy during the 1-year follow-up period, and those who required appendectomy did not experience significant complications.
Antibiotics as First-Line Therapy for Acute Appendicitis: Evidence for a Change in Clinical Practice
World Journal of Surgery, 2012
Background Randomized studies have indicated that acute appendicitis may be treated by antibiotics without the need of surgery. However, concerns have been raised about selection bias of patients in such studies. Therefore, the present study was aimed to validate previous findings in randomized studies by a full-scale population-based application. Methods All patients with acute appendicitis at Sahlgrenska University Hospital (May 2009 and February 2010) were offered intravenous piperacillin plus tazobactam according to our previous experience, followed by 9 days out-hospital oral ciprofloxacin plus metronidazole. Endpoints were treatment efficacy and complications. Efficient antibiotic treatment was defined as recovery without the need of surgery beyond 1 year of follow-up. Results A total of 558 consecutive patients were hospitalized and treated due to acute appendicitis. Seventy-nine percent (n = 442) received antibiotics as first-line therapy and 20 % (n = 111) had primary surgery as the secondline therapy. Seventy-seven percent of patients on primary antibiotics recovered while 23 % (n = 100) had subsequent appendectomy due to failed initial treatment on antibiotics. Thirty-eight patients (11 %) of the 342 had experienced recurrent appendicitis at 1-year follow-up. Primary antibiotic treatment had fewer complications compared to primary surgery. Conclusions This population-based study confirms previous results of randomized studies. Antibiotic treatment can be offered as the first-line therapy to a majority of unselected patients with acute appendicitis without medical drawbacks other than the unknown risk for long-term relapse, which must be weighed against the unpredicted but well-known risk for serious major complications following surgical intervention.
Evaluation of Antibiotics used and Treatment Outcomes in Postoperative Appendectomy Patients
ADVANCES IN MEDICAL, DENTAL AND HEALTH SCIENCES, 2019
Background: Appendicitis is condition which describes and explain inflammation of appendix. Signs and symptoms of appendicitis are generally severe discomfort in lower right part of abdominal cavity, vomiting, nausea and loss of appetite while around 40% of people do not show these distinctive characteristics of appendicitis. For management of acute appendicitis appendectomy is required on urgent basis. The incidence of surgical wound infections or surgical sites infections are greatly reduced by administration of antibiotics prophylactically. Methodology: This cross sectional study was conducted for minor and major surgery patients of appendicitis at Sandman Provincial Hospital Quetta and Bolan Medical Complex Hospital Quetta. The study was carried out over period of 4 months between May 2018 and September 2018. Convenient sampling method was adopted for enrolling study patients A standardized data collection form was developed based on recommendations of Center for Disease Control (CDC) guiding principle for inhibition of SSI was used. Ethical approval was obtained from Ethical Committee of Faculty of Pharmacy and Health Sciences, University of Balochistan Quetta. Results: Results showed that majority of patients of appendicitis 133 (68.2%) were from age group 1 to 20 years. Majority of participants that had undergone surgery for appendicitis were male 114 (58.5%). Majority of respondents belonged to the urban area i.e 123. Outcomes on follow up showed majority of the patients had healed their wound which were using prescribed antibiotics for post-operative care. Only one patient reported the sepsis. etronidazole was prescribed to most of the patient’s i.e 183, Ceftriaxone to 162, Gentamicin to 155, Moxifloxacin to 19 among other antibiotics. Conclusion: The current study demonstrated that antibiotics are rationally prescribed in tertiary care hospitals of Quetta, also prophylactic and post-operative prescribing of antibiotics yield the desired outcomes.
JAMA
IMPORTANCE Short-term results support antibiotics as an alternative to surgery for treating uncomplicated acute appendicitis, but long-term outcomes are not known. OBJECTIVE To determine the late recurrence rate of appendicitis after antibiotic therapy for the treatment of uncomplicated acute appendicitis. DESIGN, SETTING, AND PARTICIPANTS Five-year observational follow-up of patients in the Appendicitis Acuta (APPAC) multicenter randomized clinical trial comparing appendectomy with antibiotic therapy, in which 530 patients aged 18 to 60 years with computed tomography-confirmed uncomplicated acute appendicitis were randomized to undergo an appendectomy (n = 273) or receive antibiotic therapy (n = 257). The initial trial was conducted from November 2009 to June 2012 in Finland; last follow-up was September 6, 2017. This current analysis focused on assessing the 5-year outcomes for the group of patients treated with antibiotics alone. INTERVENTIONS Open appendectomy vs antibiotic therapy with intravenous ertapenem for 3 days followed by 7 days of oral levofloxacin and metronidazole. MAIN OUTCOMES AND MEASURES In this analysis, prespecified secondary end points reported at 5-year follow-up included late (after 1 year) appendicitis recurrence after antibiotic treatment, complications, length of hospital stay, and sick leave. RESULTS Of the 530 patients (201 women; 329 men) enrolled in the trial, 273 patients (median age, 35 years [IQR, 27-46]) were randomized to undergo appendectomy, and 257 (median age, 33 years, [IQR, 26-47]) were randomized to receive antibiotic therapy. In addition to 70 patients who initially received antibiotics but underwent appendectomy within the first year (27.3% [95% CI, 22.0%-33.2%]; 70/256), 30 additional antibiotic-treated patients (16.1% [95% CI, 11.2%-22.2%]; 30/186) underwent appendectomy between 1 and 5 years. The cumulative incidence of appendicitis recurrence was 34.0% (95% CI, 28.2%-40.1%; 87/256) at 2 years, 35.2% (95% CI, 29.3%-41.4%; 90/256) at 3 years, 37.1% (95% CI, 31.2%-43.3%; 95/256) at 4 years, and 39.1% (95% CI, 33.1%-45.3%; 100/256) at 5 years. Of the 85 patients in the antibiotic group who subsequently underwent appendectomy for recurrent appendicitis, 76 had uncomplicated appendicitis, 2 had complicated appendicitis, and 7 did not have appendicitis. At 5 years, the overall complication rate (surgical site infections, incisional hernias, abdominal pain, and obstructive symptoms) was 24.4% (95% CI, 19.2%-30.3%) (n = 60/246) in the appendectomy group and 6.5% (95% CI, 3.8%-10.4%) (n = 16/246) in antibiotic group (P < .001), which calculates to 17.9 percentage points (95% CI, 11.7-24.1) higher after surgery. There was no difference between groups for length of hospital stay, but there was a significant difference in sick leave (11 days more for the appendectomy group). CONCLUSIONS AND RELEVANCE Among patients who were initially treated with antibiotics for uncomplicated acute appendicitis, the likelihood of late recurrence within 5 years was 39.1%. This long-term follow-up supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis.
Acute Appendicitis and Its Management: A Hospital Based Study
https://www.ijrrjournal.com/IJRR\_Vol.8\_Issue.10\_Oct2021/IJRR-Abstract045.html, 2021
Background: Acute appendicitis is the most common acute surgical condition of the abdomen, which if complicated by perforation or peritonitis has high morbidity and mortality. Aim: The aim of this study is to analyze the presentation, diagnosis and management of acute appendicitis along with the role of conservative management in uncomplicated cases. Materials and Methods: This study was conducted in Govt. Medical College Jammu over a period of one year w.e.f. September 2017 to August 2018 and included 120 patients. Diagnosis in the suspected patients was based on history, clinical examination coupled with laboratory investigations and imaging modalities like ultrasound/ CT Scan wherever required. Results: 120 patients of acute appendicitis were treated over the period of one year at our center. Abdominal pain was the most common and constant presentation seen in 112 patients followed by vomiting (82), history of fever (60), history of constipation and distension (20) and another 12 had history of diarrhoea. Six patients (5%) responded favorably to conservative management. Conclusion: Acute appendicitis is a common surgical emergency requiring detailed history and meticulous examination coupled with X-ray and ultrasonography for diagnosis. Appendectomy is the standard procedure of choice and wherever feasible laparoscopic appendectomy offers the advantage of less pain, short hospital stay, earlier return to work and overall cost.