We want to share this Cochrane review: Appendectomy versus antibiotic treatment for acute appendicitis.

Objectives: To assess the effects of antibiotic treatment for uncomplicated/simple acute appendicitis compared with appendectomy for resolution of symptoms and complications.

Main results: 13 randomized trials with 3,358 participants were included.
In this publication, the authors conducted a comprehensive Cochrane systematic review with meta-analyses. Participants were randomized to antibiotics or appendectomy. All studies used broad-spectrum antiobiotics regimens and most studies used predominantly laparoscopic surgery. Follow-up ranged from hospital admission only to seven years.

The rigorous analysis revealed that

• It is uncertain whether there was any difference in mortality due to the very low‐certainty evidence.
• There may be more people having unsuccessful treatment in the antibiotic group compared with surgery, which did not reach our predefined level for clinical significance (risk ratio (RR) 0.91, 95% CI 0.87 to 0.96; I2 = 69%; 7 studies, 2471 participants; low‐certainty evidence).
• At one year, 30.7% of participants in the antibiotic group required appendectomy or, alternatively, more than two‐thirds of antibiotic‐treated participants avoided surgery in the first year, but the evidence is very uncertain.
• Regarding complications, it is uncertain whether there is any difference in episodes of Clostridium difficile diarrhoea due to very low‐certainty evidence. There may be a clinically significant reduction in wound infections withantibiotics. 
• It is uncertain whether antibiotics affect the incidence of intra‐abdominal abscess or collection, or reoperation due to very low‐certainty evidence, mainly due to rare events causing imprecision and risk of bias.

The authors concluded that antibiotics may be associated with higher rates of unsuccessful treatment for 76 per 1000 people, although differences may not be clinically significant. It is uncertain if antibiotics increase length of hospital stay by half a day. Antibiotics may reduce wound infections. A third of the participants initially treated with antibiotics required subsequent appendectomy or two‐thirds avoided surgery within one year, but the evidence is very uncertain. There were too few data from the included studies to comment on major complications.

Access publication here: https://doi.org/10.1002/14651858.CD015038.pub2