Prescrire international
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Prescrire international · Jun 2014
Review Meta AnalysisAntibiotic therapy for acute appendicitis in adults. Fewer immediate complications than with surgery, but more subsequent failures.
Appendectomy is the standard treatment for acute appendicitis. Since the 1990s, antibiotic therapy has sometimes been proposed as an alternative to immediate appendectomy. How effective are antibiotics in adults with uncomplicated acute appendicitis, and what is the risk of complications? To answer these questions, we conducted a review of the literature using the standard Prescrire methodology. ⋯ In practice, in early 2014, appendectomy remains the first-line treatment for uncomplicated acute appendicitis. In some still poorly characterised patients, the harm-benefit balance of antibiotic therapy is probably better than that of immediate appendectomy. When informed of the risks, some patients are likely to choose antibiotic therapy.
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In order to help healthcare professionals and patients choose high-quality treatments and avoid harms, we have updated our list of drugs to avoid in early 2014. Prescrire's assessments of the harm-benefit balance of new drugs and indications are based on a rigorous procedure that includes a systematic and reproducible literature search, identification of patient-relevant outcomes, prioritisation of the supporting evidence, based on the strength of evidence, comparison with standard treatments; and an analysis of both known and potential adverse effects. Our 2014 review concerns drugs analysed in these pages over a four-year period, from 2010 to 2013. ⋯ However, even for serious diseases, this does not justify exposing patients to serious risks when a drug has no proven efficacy. Some drugs can be used within the context of clinical trials, as long as patients enrolled in such studies are informed that the harms and benefits are uncertain and that this is precisely why they are being asked to participate in clinical research. Tailored supportive care is the best option when there are no available treatments capable of improving the prognosis, beyond the placebo effect.