South Africa needs to embrace the role of antibiotics in the treatment of acute uncomplicated appendicitis

Abstract

There has been a sea change in the management of acute appendicitis over the last quarter of a century. This arose from the realisation that with early imaging and clinical scoring systems appendicitis could be diagnosed early and the pathophysiology reversed by the timeous and appropriate administration of intravenous antibiotics. There has been a growing body of literature attesting to the efficacy of antibiotic therapy in the treatment of acute uncomplicated appendicitis.^1,2 No less an organisation than the American College of Surgeons has described antibiotic treatment of acute uncomplicated appendicitis as an “accepted first-line therapy.”³ The American college came to this conclusion based on a number of randomised trials. Most authors on the topic concur with the college that antibiotic treatment is “not inferior” to appendectomy as based on outcomes, measured up to thirty days.^1,2 This has been supported by many clinical audits and reports as well as a number of well-constructed randomised trials.