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- Hansson, Jeanette, 1972, et al.
(author)
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A Model to Select Patients Who May Benefit from Antibiotic Therapy as the First Line Treatment of Acute Appendicitis at High Probability.
- 2014
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In: Journal of Gastrointestinal Surgery. - : Springer Science and Business Media LLC. - 1091-255X .- 1873-4626. ; 18:5, s. 961-967
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Journal article (peer-reviewed)abstract
- Randomized studies indicated that 88-95% of patients with acute appendicitis recover on antibiotics without surgery, although it is unclear which patient would benefit with high probability on antibiotics. We hypothesized that patients with phlegmonous appendicitis should be a group where antibiotics may be a sufficient treatment. Accordingly, our aim was to propose a model to support treatment application for unselected patients with acute appendicitis.
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| 2. |
- Hansson, Jeanette, 1972
(author)
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Antibiotic therapy as single treatment of acute appendicitis
- 2012
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Doctoral thesis (other academic/artistic)abstract
- ABSTRACT BACKGROUND Appendectomy has been the established treatment of acute appendicitis during the last century, regarded as a simple and safe procedure, although hampered with postoperative complications and increased standard mortality. Modern research has indicated that selected patients with acute appendicitis can be treated by antibiotic therapy alone. The aim of this thesis was therefore to explore antibiotic therapy as single treatment of acute appendicitis in unselected adult patients. A secondary aim was to suggest a model for prediction of antibiotic response. MATERIALS AND METHODS Two prospective interventional studies were performed on consecutive patients with acute appendicitis. First, a randomized controlled trial (paper I) with 369 patients compared antibiotic therapy with appendectomy. Primary outcome was treatment efficacy and major complications. Second, a population based study (paper II) with antibiotics as first line therapy included 558 patients. The patients were followed for one year in both studies. In paper III, retrospective analyses of preoperative parameters for 384 patients were linked to the histopathological reports of resected appendices regarding the stage of appendicitis in order to create a model for prediction of antibiotic response. The model was then validated on the patients in the population based study (paper II). In paper IV we used the same patients as in paper II, where sequential measures of procalcitonin were analysed in order to evaluate the efficacy of initiated antibiotic therapy. RESULTS A majority of patients with acute appendicitis could be treated with antibiotics in both prospective studies; 5-10% were clinically judged to need primary surgery. The recovery rate on antibiotics was 91% in the RCT and 77% in the population based study. The recurrence rate after one year was 14% and 11% respectively. Antibiotic treatment displayed less overall complications compared to primary surgery in both studies. Complications after antibiotic therapy consisted mainly of side effects to the antibiotics or postoperative complications after rescue surgery, but intra-abdominal abscesses were also seen. Prediction models for patient selection, based on standard laboratory parameters, could identity patients with positive antibiotic response at increased probability but at low sensitivity. Procalcitonin had limited value for early evaluation of the efficiency of provided antibiotic therapy in acute appendicitis. CONCLUSIONS Acute appendicitis in unselected adults can be treated with antibiotics as single therapy with high recovery rate and low recurrence rate within one year. Antibiotics can be offered to a majority of patients without the risk of increased complications. Long-term follow up are warranted.
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| 3. |
- Hansson, Jeanette, 1972, et al.
(author)
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Antibiotics as First-line Therapy for Acute Appendicitis: Evidence for a Change in Clinical Practice.
- 2012
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In: World journal of surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 36:9, s. 2028-36
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Journal article (peer-reviewed)abstract
- Randomized studies have indicated that acute appendicitis may be treated by antibiotics without the need of surgery. However, concerns have been raised about selection bias of patients in such studies. Therefore, the present study was aimed to validate previous findings in randomized studies by a full-scale population-based application.
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| 4. |
- Hansson, Jeanette, 1972, et al.
(author)
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Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients.
- 2009
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In: The British journal of surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 96:5, s. 473-81
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Journal article (peer-reviewed)abstract
- BACKGROUND: A trial in selected men suggested that antibiotic therapy could be an alternative to appendicectomy in appendicitis. This study aimed to evaluate antibiotic therapy in unselected men and women with acute appendicitis. METHODS: Consecutive patients were allocated to study (antibiotics) or control (surgery) groups according to date of birth. Study patients received intravenous antibiotics for 24 h and continued at home with oral antibiotics for 10 days. Control patients had a standard appendicectomy. Follow-up at 1 and 12 months was carried out according to intention and per protocol. RESULTS: Study and control patients were comparable at inclusion; 106 (52.5 per cent) of 202 patients allocated to antibiotics completed the treatment and 154 (92.2 per cent) of 167 patients allocated to appendicectomy had surgery. Treatment efficacy was 90.8 per cent for antibiotic therapy and 89.2 per cent for surgery. Recurrent appendicitis occurred in 15 patients (13.9 per cent) after a median of 1 year. A third of recurrences appeared within 10 days and two-thirds between 3 and 16 months after hospital discharge. Minor complications were similar between the groups. Major complications were threefold higher in patients who had an appendicectomy (P < 0.050). CONCLUSION: Antibiotic treatment appears to be a safe first-line therapy in unselected patients with acute appendicitis. Registration number: NCT00469430 (http://www.clinicaltrials.gov).
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