management

Last reviewed 01/2018

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 uncomplicated acute appendicitis (1)
  • evidence shows that antibiotics can be used safely as primary treatment in patients presenting with acute uncomplicated appendicitis
  • antibiotic treatment was not associated with an increased perforation rate compared with surgery, nor were any significant differences seen in the length of stay or treatment efficacy between antibiotics and appendicectomy
  • an early trial of antibiotics merits consideration as the initial treatment option for uncomplicated appendicitis

Reference:

• Varadhan KK, Neal KR, Lobo DN, et al. Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. BMJ 2012;344:e215