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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, December 22, 2016

Antibiotics vs Surgery for Appendicitis

St.Emlyn's - By Carley S - December 21, 2016
..."A recent paper in the Annals of Emergency Medicine on the use of antibiotics to treat low grade appendicitis in the out patient setting. Now the concept of treating appendicitis with antibiotics is not new and there are RCTs, non randomised trials3–13 and meta-analyses14–16 to support this approach, although antibiotic therapy is not without risks (e.g. recurrent appendicitis). There is little published evidence to date about whether antibiotic therapy can be safely achieved in the outpatient setting which would of course be relevant to emergency physicians. The abstract fornthis weeks paper is below, please have a read but of course we always recommend that you read the whole paper...
What is interesting to me is that outpatient management of appendicitis is already taking place in some places. In hospitals near Virchester the concept of a surgical hot clinic (essentially ambulatory care of adult surgical conditions such as low grade appendicitis, abscesses, biliary colic etc.) has been developed. In the UK these innovations have been borne from the need to reduce hospital admissions as a result of the combination of a declining bed base together with an ageing population. The resultant ED overcrowding is a real problem and any innovation leading to a reduction in the number of patients admitted to hospital is welcome, but we can and should only advocate it if there it’s safe for our patients. On this occasion it looks as though pragmatic clinical change is preceeding the evidential change. Ross Fisher raises some quite real concerns about this in the comment below (please read it). Do we really know the natural history of the disease without conducting well designed trials and might pragmatism without evidence put our patients at risk?