• Napaphat Poprom, Pawin Numthavaj, Chumpon Wilasrusmee, Sasivimol Rattanasiri, John Attia, Mark McEvoy, and Ammarin Thakkinstian.
• Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand; Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.
• Am. J. Surg. 2019 Jul 1; 218 (1): 192-200.

BackgroundThe efficacy of antibiotics in appendicitis remains controversial, and physicians are not confident in prescribing antibiotics as the first line treatment. This network meta-analysis was conducted to assess the efficacy and safety of individual antibiotics in uncomplicated appendicitis.MethodsRandomized controlled trials (RCTs) were identified from MEDLINE and SCOPUS databases since inception to July 2017.StudiesNetwork meta-analysis was applied to estimate treatment effects and safety. Probability of being the best treatment was estimated using surface under the cumulative ranking curve (SUCRA).ResultsAmong 9 RCTs meeting our inclusion criteria. A network meta-analysis indicated that those receiving antibiotics had about 12-32% lower chance of treatment success and lower risk of complication about 23-86%, especially Beta-lactamase than appendectomy. The overall appendicitis recurrence rate in the antibiotic group was about 18.2%. The SUCRA indicated that appendectomy was ranked first for treatment success and least complications, followed by Beta-lactamase.ConclusionsAppendectomy is still the most effective treatment in uncomplicated appendicitis but it carries complications. Beta-lactamase, might be an alternative treatment if there are any contraindications for operation.Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

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