Gastrointestinal

Topic 1 - Summary
1. Citation:

Salminen, Paulina, Hannu Paajanen, Tero Rautio, Pia Nordström, Markku Aarnio, Tuomo Rantanen, Risto Tuominen, Saija Hurme, Johanna Virtanen, Jukka-Pekka Mecklin, Juhani Sand, Airi Jartti, Irina Rinta-Kiikka, and Juha M. Grönroos. "Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis." JAMA (2015): 2340. Print.

2. Summary/Bottom Lines:

Most patients given antibiotics for CT proven uncomplicated appendicitis did not require appendectomy within the first year. Those who eventually required surgery did not have higher adverse outcome versus initial appendectomy. However, the study showed that the antibiotic group did not meet non-inferiority as compared with appendectomy.

3. Methods:

This was a multicenter noninferiority RCT. Based on previous studies on antibiotic treatment for appendicitis, the paper assumed there would be a 24% difference in treatment efficacy between the surgical and antibiotic groups. The surgical group received an open appendectomy, while the antibiotic group received a 3 day hospital stay for IV antibiotics, along with a 7 day course of home oral antibiotics. The difference shown was 27%, which makes antibiotics only for CT proven uncomplicated appendicitis, in this study, inferior.

4. Limits:

The study set out to show noninferiority of antibiotics for uncomplicated appendicitis versus surgery; it was not able to do this. The higher complication rate in the surgery group was with open appendectomy. However, laparoscopic appendectomy tend to have less complications and less postoperative pain. Additionally, the study did not account for comorbidities and, in doing this, favors noninferiority.

5. Additional Info:

 ● There are studies aiming to treat uncomplicated appendicitis

● Given the right population and antibiotic regimen, this may eventually be feasible.

● Surgery is still gold standard for appendicitis.

6. Author: Dr. Michael Tran