Telaah Kritis

Safety and efficacy of antibiotics compared

with appendicectomy for treatment of
uncomplicated acute appendicitis: meta-
analysis of randomised controlled trials
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2156 (Published 05 April 2012) Cite this as:
BMJ 2012;344:e2156
1. Krishna K Varadhan, research fellow1,
2. Keith R Neal, professor12,
3. Dileep N Lobo, professor1

1. Did the review address a clearly focused question?

Answer: Yes

To compare the safety and efficacy of antibiotic treatment versus appendicectomy for the primary
treatment of uncomplicated acute appendicitis

2. Did the authors look for the right type of papers?

Answer: Yes

The primary outcome measure was complications. The secondary outcome measures were efficacy of
treatment, length of stay, and incidence of complicated appendicitis and readmissions.

Is it worth continuing?

Answer: Yes

3. Do you think all the important, relevant studies were included?

Answer: Yes

4. Did the reviewers authors do enough to asses the quality of the included studies?

Answer: Yes
5. If the results of the studies have been combined, was it reasonable to do so?

Answer: Yes

6. What are the overall results of the review?

Four randomised controlled trials with a total of 900 patients (470 antibiotic treatment, 430
appendicectomy) met the inclusion criteria. Antibiotic treatment was associated with a 63% (277/438)
success rate at one year. Meta-analysis of complications showed a relative risk reduction of 31% for
antibiotic treatment compared with appendicectomy (risk ratio (Mantel-Haenszel, fixed) 0.69 (95%
confidence interval 0.54 to 0.89); I2=0%; P=0.004). A secondary analysis, excluding the study with
crossover of patients between the two interventions after randomisation, showed a significant relative
risk reduction of 39% for antibiotic therapy (risk ratio 0.61 (0.40 to 0.92); I2=0%; P=0.02). Of the 65 (20%)
patients who had appendicectomy after readmission, nine had perforated appendicitis and four had
gangrenous appendicitis. No significant differences were seen for treatment efficacy, length of stay, or
risk of developing complicated appendicitis.

7. How precise are these results?

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8. Can the results be applied to the local population?

Answer: Yes

9. Were all important outcomes considered?

Answer: Yes

10. Are the benefits worth the harms and cost?

Answer: Yes