Antibiotics Versus Appendicectomy for the Treatment of Uncomplicated Acute Appendicitis: An Updated Meta-Analysis of Randomised Controlled Trials by Rollins et al.

Antibiotics Versus Appendicectomy for the Treatment of Uncomplicated Acute Appendicitis: An... World J Surg (2017) 41:2411 DOI 10.1007/s00268-016-3864-8 LETTE R T O T HE EDI T OR Antibiotics Versus Appendicectomy for the Treatment of Uncomplicated Acute Appendicitis: An Updated Meta-Analysis of Randomised Controlled Trials by Rollins et al. 1 1 1 1 • • • J. C. Harnoss P. Probst M. W. Bu ¨ chler M. K. Diener Published online: 3 January 2017 Socie ´te ´ Internationale de Chirurgie 2016 Dear Editors, meta- and subgroup analyses revealed that treatment failure We read the article by Rollins et al. [1] with great of antibiotics occurred in 46.4% up to 1 year after the interest. This updated systematic review and meta-analysis initial hospital stay and the risk of complicated appendicitis is showing an intensive reflection of current debates and was significantly increased by twofold [2]. In conclusion, thus deserves a comment on results and its final conclusion surgery represents a final treatment with a clear risk profile that antibiotics should be prescribed once a diagnosis of and important factors on antibiotic therapy are yet unin- acute appendicitis is made or considered and that the pri- vestigated (e.g. quality of life). Therefore, we plead for mary treatment of acute uncomplicated appendicitis should further RCTs and a transparent discussion of treatment be antibiotics. options, interdisciplinary and patient-oriented in cases with In our opinion [2], this conclusion is hastily and not suspected acute, uncomplicated appendicitis rather than a supported by current available data. The main general premature change of paradigm based on currently insuffi- critics are that we do not have any data about peri-inter- cient data. ventional quality of life of our patients and no follow-up of Compliance with ethical standards longer than one year after initial therapy. Moreover, adverse events of the antibiotic therapy were insufficiently Conflict of interest The authors declare that they have no conflict of reported by most of trials. Besides the fact that the choice, interest. application form, dosage and treatment duration of antibi- otics are unclear, we should be aware of the risk of sup- References porting antibiotic resistances and danger to treat malignancies with antibiotics if not performing a CT scan 1. Rollins KE, Varadhan KK, Neal KR et al (2016) Antibiotics versus which will have its own drawbacks. Furthermore, none of appendicectomy for the treatment of uncomplicated acute appen- the trials investigating antibiotics as primary therapy con- dicitis: an updated meta-analysis of randomised controlled trials. sidered repeating hospital stays as burden of this kind of World J Surg 40:2305–2318. doi:10.1007/s00268-016-3561-7 2. Harnoss JC, Zelienka I, Probst P et al (2016) Antibiotics versus treatment. surgical therapy for uncomplicated appendicitis: systematic review In accordance with our results, antibiotics may prevent and meta-analysis of controlled trials (PROSPERO 2015: 62.6–72.6% of patients from appendectomies [1, 2]. Nev- CRD42015016882). Ann Surg (epub ahead of print) ertheless, going one step further, thorough and proper & M. K. Diener markus.diener@med.uni-heidelberg.de Department of General, Visceral and Transplantation Surgery and Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png World Journal of Surgery Springer Journals

Antibiotics Versus Appendicectomy for the Treatment of Uncomplicated Acute Appendicitis: An Updated Meta-Analysis of Randomised Controlled Trials by Rollins et al.

Free
1 page

Loading next page...
1 Page
 
/lp/springer_journal/antibiotics-versus-appendicectomy-for-the-treatment-of-uncomplicated-8alJIWpXnP
Publisher
Springer International Publishing
Copyright
Copyright © 2016 by Société Internationale de Chirurgie
Subject
Medicine & Public Health; Surgery; Abdominal Surgery; Cardiac Surgery; General Surgery; Thoracic Surgery; Vascular Surgery
ISSN
0364-2313
eISSN
1432-2323
D.O.I.
10.1007/s00268-016-3864-8
Publisher site
See Article on Publisher Site

Abstract

World J Surg (2017) 41:2411 DOI 10.1007/s00268-016-3864-8 LETTE R T O T HE EDI T OR Antibiotics Versus Appendicectomy for the Treatment of Uncomplicated Acute Appendicitis: An Updated Meta-Analysis of Randomised Controlled Trials by Rollins et al. 1 1 1 1 • • • J. C. Harnoss P. Probst M. W. Bu ¨ chler M. K. Diener Published online: 3 January 2017 Socie ´te ´ Internationale de Chirurgie 2016 Dear Editors, meta- and subgroup analyses revealed that treatment failure We read the article by Rollins et al. [1] with great of antibiotics occurred in 46.4% up to 1 year after the interest. This updated systematic review and meta-analysis initial hospital stay and the risk of complicated appendicitis is showing an intensive reflection of current debates and was significantly increased by twofold [2]. In conclusion, thus deserves a comment on results and its final conclusion surgery represents a final treatment with a clear risk profile that antibiotics should be prescribed once a diagnosis of and important factors on antibiotic therapy are yet unin- acute appendicitis is made or considered and that the pri- vestigated (e.g. quality of life). Therefore, we plead for mary treatment of acute uncomplicated appendicitis should further RCTs and a transparent discussion of treatment be antibiotics. options, interdisciplinary and patient-oriented in cases with In our opinion [2], this conclusion is hastily and not suspected acute, uncomplicated appendicitis rather than a supported by current available data. The main general premature change of paradigm based on currently insuffi- critics are that we do not have any data about peri-inter- cient data. ventional quality of life of our patients and no follow-up of Compliance with ethical standards longer than one year after initial therapy. Moreover, adverse events of the antibiotic therapy were insufficiently Conflict of interest The authors declare that they have no conflict of reported by most of trials. Besides the fact that the choice, interest. application form, dosage and treatment duration of antibi- otics are unclear, we should be aware of the risk of sup- References porting antibiotic resistances and danger to treat malignancies with antibiotics if not performing a CT scan 1. Rollins KE, Varadhan KK, Neal KR et al (2016) Antibiotics versus which will have its own drawbacks. Furthermore, none of appendicectomy for the treatment of uncomplicated acute appen- the trials investigating antibiotics as primary therapy con- dicitis: an updated meta-analysis of randomised controlled trials. sidered repeating hospital stays as burden of this kind of World J Surg 40:2305–2318. doi:10.1007/s00268-016-3561-7 2. Harnoss JC, Zelienka I, Probst P et al (2016) Antibiotics versus treatment. surgical therapy for uncomplicated appendicitis: systematic review In accordance with our results, antibiotics may prevent and meta-analysis of controlled trials (PROSPERO 2015: 62.6–72.6% of patients from appendectomies [1, 2]. Nev- CRD42015016882). Ann Surg (epub ahead of print) ertheless, going one step further, thorough and proper & M. K. Diener markus.diener@med.uni-heidelberg.de Department of General, Visceral and Transplantation Surgery and Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany

Journal

World Journal of SurgerySpringer Journals

Published: Jan 3, 2017

References

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off