Antibiotics in acute appendicitis. When and how? A general review

L. Alecu; C. Niţipir; Iulian Slavu; V. Braga; D. Mihăilă; A. Tulin

doi:10.33695/jss.v6i1.258

L. Alecu General Surgery Clinic, Prof. Dr.”Agrippa Ionescu” Emergency Clinical Hospital, Bucharest, Romania
C. Niţipir Emergency Clinical Hospital Elias, Bucharest, Romania
Iulian Slavu Sp Clinic de Urgenta Bucuresti
V. Braga General Surgery Clinic, Emergency Clinical Hospital, Bucharest, Romania
D. Mihăilă General Surgery Clinic, Prof. Dr.”Agrippa Ionescu” Emergency Clinical Hospital, Bucharest, Romania
A. Tulin Clinic of General Surgery ”Prof. Dr. Agrippa Ionescu” Emergency Hospital, Bucharest, Romania

DOI: https://doi.org/10.33695/jss.v6i1.258

Keywords: antibiotic treatment, acute appendicitis

Abstract

Introduction: An increasing interest exits towards the use of antibiotics in the treatment of uncomplicated acute appendicitis.Discussion: For a long period of time, surgery was the only treatment for acute appendicitis. Due to recent research in the etiology of acute appendicitis which seems to be driven by intraluminal bacterial proliferation, new data suggests that for non-perforated appendicitis confirmed with the help of CT, antibiotics may play a central role in the treatment. As relapse rates amount in some cases to only 5% after antibiotic treament, a discussion is required regarding the risks of interval appendectomy and its use. The debate regarding the optimal antibiotic course is on-going as some surgeons advocate for amoxicillin/clavulanic while others, due to acquired resistance recommend Ertapenem.Conclusion: Selective antibiotic treatment for selected forms of acute appendicitis, uncomplicated without perforation is safe and has a relatively low complication rate. However, certain mentions must be made: surgery must not be delayed if failure of antibiotics exists as it can lead to higher rates of peritonitis. Close clinical surveillance is of utmost importance