Skip to main content


Log in

Antibiotic Therapy Versus Appendectomy for Acute Appendicitis: A Meta-Analysis

  • Published:
World Journal of Surgery Aims and scope Submit manuscript



Antibiotic treatment has been shown to be effective in treating selected patients with acute appendicitis, and three randomized controlled trials (RCTs) have compared the efficacy of antibiotic therapy alone with that of surgery for acute appendicitis. The purpose of this meta-analysis of RCTs was to assess the outcomes with these two therapeutic modalities.


All RCTs comparing antibiotic therapy alone with surgery in patients over 18 years of age with suspected acute appendicitis were included. Patients with suspected perforated appendix or peritonitis, and those with an allergy to antibiotics had been excluded in the RCTs. The outcome measures studied were complications, length of hospital stay, and readmissions.


Meta-analysis of RCTs of antibiotic therapy versus surgery showed a trend toward a reduced risk of complications in the antibiotic-treated group [RR (95%CI): 0.43 (0.16, 1.18) p = 0.10], without prolonging the length of hospital stay [mean difference (inverse variance, random, 95% CI): 0.11 (−0.22, 0.43) p = 0.53]. Of the 350 patients randomized to the antibiotic group, 238 (68%) were treated successfully with antibiotics alone and 38 (15%) were readmitted. The remaining 112 (32%) patients randomized to antibiotic therapy crossed over to surgery for a variety of reasons. At 1 year, 200 patients in the antibiotic group remained asymptomatic.


This meta-analysis suggests that although antibiotics may be used as primary treatment for selected patients with suspected uncomplicated appendicitis, this is unlikely to supersede appendectomy at present. Selection bias and crossover to surgery in the RCTs suggest that appendectomy is still the gold standard therapy for acute appendicitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others


  1. Simpson J, Samaraweera AP, Sara RK et al (2008) Acute appendicitis—a benign disease? Ann R Coll Surg Engl 90:313–316

    Google Scholar 

  2. Wen SW, Naylor CD (1995) Diagnostic accuracy and short-term surgical outcomes in cases of suspected acute appendicitis. Can Med Assoc J 152:1617–1626

    CAS  Google Scholar 

  3. Bauer T, Vennits B, Holm B et al (1989) Antibiotic prophylaxis in acute nonperforated appendicitis. The Danish Multicenter Study Group III. Ann Surg 209:307–311

    Article  CAS  PubMed  Google Scholar 

  4. Mui LM, Ng CS, Wong SK et al (2005) Optimum duration of prophylactic antibiotics in acute non-perforated appendicitis. Aust N Z J Surg 75:425–428

    Article  Google Scholar 

  5. Winslow RE, Dean RE, Harley JW (1983) Acute nonperforating appendicitis. Efficacy of brief antibiotic prophylaxis. Arch Surg 118:651–655

    CAS  PubMed  Google Scholar 

  6. Andersen BR, Kallehave FL, Andersen HK (2005) Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev:CD001439

  7. Hansson J, Korner U, Khorram-Manesh A et al (2009) Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg 96:473–481

    Article  CAS  PubMed  Google Scholar 

  8. Styrud J, Eriksson S, Nilsson I et al (2006) Appendectomy versus antibiotic treatment in acute appendicitis. A prospective multicenter randomized controlled trial. World J Surg 30:1033–1037

    Article  PubMed  Google Scholar 

  9. Eriksson S, Granstrom L (1995) Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis. Br J Surg 82:166–169

    Article  CAS  PubMed  Google Scholar 

  10. The Nordic Cochrane Centre (2008) Review Manager Version 5 Software. The Cochrane Collaboration, Copenhagen, Denmark. Available from Accessed 1 July 2009

  11. Cleophas TJ, Zwinderman AH (2008) Random effects models in clinical research. Int J Clin Pharmacol Ther 46:421–427

    CAS  PubMed  Google Scholar 

  12. The Cochrane Collaboration Open Learning Material (2002) Summary statistics for dichotomous outcome data. The Cochrane Collaboration, Copenhagen, Denmark. Available from Accessed 1 July 2009

  13. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  CAS  PubMed  Google Scholar 

  14. Flum DR, Koepsell T (2002) The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 137:799–804 discussion 804

    Article  PubMed  Google Scholar 

  15. Humes DJ, Simpson J (2006) Acute appendicitis. BMJ 333:530–534

    Article  CAS  PubMed  Google Scholar 

  16. Corfield L (2007) Interval appendicectomy after appendiceal mass or abscess in adults: what is “best practice”? Surg Today 37:1–4

    Article  PubMed  Google Scholar 

  17. Cobben LP, de Van Otterloo AM, Puylaert JB (2000) Spontaneously resolving appendicitis: frequency and natural history in 60 patients. Radiology 215:349–352

    CAS  PubMed  Google Scholar 

  18. Franke C, Gerharz CD, Bohner H et al (2002) Neurogenic appendicopathy: a clinical disease entity? Int J Colorectal Dis 17:185–191

    Article  CAS  PubMed  Google Scholar 

  19. Hofler H, Kasper M, Heitz PU (1983) The neuroendocrine system of normal human appendix, ileum and colon, and in neurogenic appendicopathy. Virchows Arch A Pathol Anat Histopathol 399:127–140

    Article  CAS  PubMed  Google Scholar 

  20. Mueller BA, Daling JR, Moore DE et al (1986) Appendectomy and the risk of tubal infertility. N Engl J Med 315:1506–1508

    Article  CAS  PubMed  Google Scholar 

  21. Lopez PP, Cohn SM, Popkin CA et al (2007) The use of a computed tomography scan to rule out appendicitis in women of childbearing age is as accurate as clinical examination: a prospective randomized trial. Am Surg 73:1232–1236

    PubMed  Google Scholar 

  22. Raman SS, Osuagwu FC, Kadell B et al (2008) Effect of CT on false positive diagnosis of appendicitis and perforation. N Engl J Med 358:972–973

    Article  CAS  PubMed  Google Scholar 

  23. Franke C, Bohner H, Yang Q et al (1999) Ultrasonography for diagnosis of acute appendicitis: results of a prospective multicenter trial. Acute Abdominal Pain Study Group. World J Surg 23:141–146

    Article  CAS  PubMed  Google Scholar 

  24. Lee CC, Golub R, Singer AJ et al (2007) Routine versus selective abdominal computed tomography scan in the evaluation of right lower quadrant pain: a randomized controlled trial. Acad Emerg Med 14:117–122

    Article  PubMed  Google Scholar 

  25. Augustin T, Bhende S, Chavda K et al (2009) CT scans and acute appendicitis: a five-year analysis from a rural teaching hospital. J Gastrointest Surg 13:1306–1312

    Article  PubMed  Google Scholar 

  26. Moteki T, Ohya N, Horikoshi H (2009) Prospective examination of patients suspected of having appendicitis using new computed tomography criteria including “maximum depth of intraluminal appendiceal fluid greater than 2.6 mm”. J Comput Assist Tomogr 33:383–389

    Article  PubMed  Google Scholar 

  27. Poortman P, Lohle PN, Schoemaker CM et al (2009) Improving the false-negative rate of CT in acute appendicitis—reassessment of CT images by body imaging radiologists: a blinded prospective study. Eur J Radiol [epub ahead of print]

  28. Olsen JB, Myren CJ, Haahr PE (1993) Randomized study of the value of laparoscopy before appendicectomy. Br J Surg 80:922–923

    Article  CAS  PubMed  Google Scholar 

  29. Bennett J, Boddy A, Rhodes M (2007) Choice of approach for appendicectomy: a meta-analysis of open versus laparoscopic appendicectomy. Surg Laparosc Endosc Percutan Tech 17:245–255

    Article  PubMed  Google Scholar 

  30. Chung RS, Rowland DY, Li P et al (1999) A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy. Am J Surg 177:250–256

    Article  CAS  PubMed  Google Scholar 

Download references


This work was supported in part by a Research Fellowship (K.K.V.) from the Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, Nottingham, UK.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Dileep N. Lobo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Varadhan, K.K., Humes, D.J., Neal, K.R. et al. Antibiotic Therapy Versus Appendectomy for Acute Appendicitis: A Meta-Analysis. World J Surg 34, 199–209 (2010).

Download citation

  • Published:

  • Issue Date:

  • DOI: