Is amoxicillin plus clavulanic acid non-inferior to appendicectomy for the treatment of uncomplicated acute appendicitis?

Excerpt

Urgent appendectomy is still considered the gold standard treatment for patients with acute appendicitis. Although it is well tolerated by most patients, it can be associated with postoperative complications in a significant number of individuals: small bowel obstruction requiring surgical intervention occurs in 3% of patients undergoing appendectomy over 10 years [1]. Furthermore, more than 15% of individuals with suspected acute appendicitis have a normal appendix at laparotomy, with a higher percentage in infants, young women and elderly patients [2]. It is still unclear if the use of diagnostic imaging reduces the frequency of unnecessary appendectomy. Therefore, in recent years there has been increased interest in antibiotic therapy as the primary treatment for acute appendicitis. Previous randomized trials comparing antibiotic therapy with emergent appendectomy conclude that acute appendicitis can be successfully treated with antibiotics [3, 4]. However, protocol design limitations of these studies weaken the relevance of their results. Consequently it is still unclear whether antibiotics are a valid alternative to surgery for patients with acute uncomplicated appendicitis. …