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Management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Management involve adequate analgesia with prompt appendicectomy as a definitive treatment.

In the (relatively rare) cases where a decision has been made to treat conservatively rather than operatively, or in the more common instance where surgery must be delayed, then:

  • patient is kept nil by mouth
  • analgesia, for example diclofenac and pethidine im
  • an antiemetic may be required
  • antibiotics, particularly cefuroxime and metronidazole intravenously, reduce the risk of generalised peritonitis and appendix abscess
  • hydration is maintained by intravenous fluids
  • paracetamol, rectally, may be used to control hyperpyrexia

Notes:

  • comparing antibiotic treatment and appendicectomy for acute appendicitis (1,2)
    • surgical appendicectomy remains the best treatment for acute appendicitis in patients fit enough for surgery (1)
    • athough antibiotic treatment can be effective in patients with uncomplicated appendicitis some will still require surgery, which may be more extensive if antibiotics fail and surgery is delayed, and there is a substantial risk of recurrence (1)
      • is possible to categorize acute appendicitis as complicated or uncomplicated (2)
        • an abscess, phlegmon, or perforation are consequences of complicated appendicitis
      • antibiotic regimes in acute uncomplicated appendicitis (2)
        • most popular combination is cephalosporin with nitroimidazole, followed by quinolones and penicillin with a beta-lactamase inhibitor
    • up to 30% of patients treated with firstline antibiotics will require surgery, and there is a substantial risk of recurrence (1)
    • delaying surgery increases the risks of more extensive intervention with associated costs for patients and health system (1)

Reference:

  • Malik A K, Innes A H, Reddy L, Munro C, Phillips A W. Appendicectomy remains treatment of choice for patients with acute appendicitis BMJ 2023; 382 :e074652 doi:10.1136/bmj-2022-0746524
  • Yadao S, Lamture Y, Huse S. Uses of Antibiotics Alone in Case of Uncomplicated Appendicitis. Cureus. 2022 Aug 27;14(8):e28488. doi: 10.7759/cureus.28488. PMID: 36176829; PMCID: PMC9513284

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