Place du traitement non opératoire dans les appendicites aiguës. Étude rétrospective chez 44 patients

Methods of conservative antibiotic treatment of acute uncomplicated appendicitis: A systematic review

“…8 Findings suggesting perforation were also common exclusion criteria, but these varied and included extraluminal gas, periappendiceal and intraperitoneal fluid (amount unspecified), and appendiceal diameter of greater than 11 mm. Appendicolith was an exclusion criterion in some studies 9,18,23,27–30,32,33,39,40,42,43 and was associated with antibiotic nonresponse or recurrence in some trials 8,19,21,35,37,41 and not in others. 4–7,11,20,22,24–26,31,34,36,38 Imaging findings suggestive of tumor were exclusion criteria in some adult trials, 8,9,11,24,31 with criteria either unspecified or based on an appendiceal diameter of greater than 15 mm.…”

“…Total intravenous and oral antibiotic duration ranged from 4 to 15 days. The most common total antibiotic duration was 10 days, which was used in 12 trials (35%) 4,6,9–11,18,19,21,22,29,31,39 ; seven trials (21%) used 7 days. 20,24,27,30,36,40,41 The shortest duration was 4 days, used in four trials (12%).…”

“…Participants were prohibited oral intake 12 hours in two studies (6%), 12,18 24 hours in nine studies (26%), 5,7,10,25,27,28,34,37,43 and 48 hours in one study (3%), 33 and allowed diet as tolerated in seven (21%; four pediatric and three adults trials) 11,20,21,23,26,32,40 ; diet was unspecified in 15 studies (44%). 4,6,8,9,22,24,29–31,35,36,38,39,41,42…”

“…Trials differed regarding the time limit to demonstrate improvement before transition to appendectomy. Eight trials (24%) evaluated response within 24 hours, 9,18–22,36,38 eight (24%) between 24 and 48 hours, 5,7,28,32,35,39,41,42 and five (15%) after 48 to 72 hours, 8,11,24,27,33 and in 13 (38%), this was unspecified. 4,6,10,23,25,26,29–31,34,37,40,43 Studies also varied in the specific criteria for antibiotic nonresponse.…”

“…We explored comparison of four (12%) outlier studies with initial antibiotic response rates in the 60% to 70% range 19,21,35,40 to 30 trials (88%) with rates 80% or greater 1–18,20,22–34,36–39,41–43 with regard to components of conservative management that might affect outcomes: inclusion of patients with abscess or unspecified, 50% versus 27%; inclusion of patients with appendicolith or unspecified, 75% versus 60%; use of a guideline nonrecommended intravenous and oral antibiotic or unspecified, 25% versus 17%; total antibiotic duration of less than 7 days or unspecified, 25% versus 23%; and allowed time for clinical response less than or equal to 24 hours or unspecified, 75% versus 62%, respectively.…”