Table 2 A summary of the studies comparing non-operative management and appendectomy
Study, Study Design | Year of publication | Medical Treatment | Surgical Treatment | No. of Patients | Outcome | Remarks |
|---|---|---|---|---|---|---|
Eriksson et al. [6] Pilot RCT | 1995 | IV cefotaxime 2 g BID and tinidazole 800 mg daily for 2 days, followed by oral ofloxacin 200 mg BID and tinidazole 500 mg BID for 8 days | Open appendectomy | S:20 + M:20 = T:40 | NOM was superior to Appendectomy in pain control NOM had a recurrence rate of 35% in 17 months NOM could effectively manage AUA | CT not applied for diagnosis of appendicitis |
Styrud et al. [12] RCT | 2006 | IV cefotaxime for 2 days and tinidazole 800 mg daily, followed by ofloxacin 200 mg | Open or laparoscopic approach on surgeon preference | S:124 + M:128 = T: 252 | Appendectomy had a higher complication rate NOM could successfully manage AUA | Female patients excluded |
Hansson et alia [13] RCT | 2009 | IV cefotaxime 1 g BID and metronidazole 1·5 g q24hr for 1 day, followed by oral ciprofloxacin 500 mg BID and metronidazole 400 mg TID for 10 days | Open or laparoscopic approach as surgeons’ usual practice | S:167 + M:202 = T:369 | NOM was safe in AUA NOM had a recurrence rate of 13.9% in 1 year Appendectomy was 3 folds higher in major complication rate Minor complication rate was similar | This study has a high cross over rate from NOM to appendectomy. |
Malik et al. [11] RCT | 2009 | IV ciprofloxacin 500 mg BID and metronidazole 500 mg TID for 2 days, followed by oral ciprofloxacin 500 mg BID and tinidazole 600 mg BID for 7 days | Approach not specified | S:40 + M:40 = T:80 | NOM was superior to Appendectomy in pain control NOM was superior in lowering white cell count and temperature in early course NOM had more recurrence | This article was retracted due to plagiarism. |
Turhan et al. [14] RCT | 2009 | IV ampicillin 1 g QID, gentamicin 160 mg daily and metronidazole 500 mg TID for 3 days, followed by oral antibiotics for 10 days | Open or laparoscopic appendectomy | S:183 + M:107 = T: 290 | Appendectomy was superior to NOM in length of hospital stay NOM cost less than Appendectomy No difference in morbidity | |
Vons et al. [15] RCT | 2011 | Amoxicillin and clavulanic Acid of 3 g or 4 g according to weight, with route and duration according to clinical symptoms | Open or laparoscopic approach on surgeon preference | S:123 + M:120 = T: 243 | Appendectomy was superior to NOM | |
Salminen et al. [19] RCT | 2015 | IV ertapenem 1 g daily for 3 days, followed by oral levofloxacin 500 mg daily and metronidazole 500 mg TID for 7 days | Open appendectomy | S:273 + M:257 = T: 530 | Appendectomy had a higher overall complication rate than NOM NOM had longer hospital stay NOM failed to demonstrate non-inferiority No significant difference in treatment efficacy |