Effect of antibiotic therapy versus no antibiotics on nonoperative management outcomes in uncomplicated appendicitis: A systematic review and meta-analysis
Abstract
Purpose: Although antibiotics are a recognized alternative to appendectomy for uncomplicated appendicitis, their specific benefit over observation alone remains unclear. This systematic review and meta-analysis aimed to isolate the antibiotic effect by directly contrasting antibiotics with observation in patients receiving nonoperative management (NOM) for uncomplicated appendicitis.
Methods: We systematically searched PubMed, Embase (Ovid), the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the International Clinical Trials Registry Platform, and the International Standard Randomized Controlled Trial Number Registry from inception to October 5, 2025, to identify randomized or quasi-randomized trials comparing antibiotics versus observation (no antibiotics) for NOM. We defined treatment success at 30 days as the primary endpoint. To assess the potential risk-of-bias (ROB), the Cochrane RoB 2 instrument was employed, while the overall certainty of our findings was determined through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.
Results: Three trials involving 437 participants were included: two randomized controlled trials (RCTs) and one quasi-RCT. Analysis restricted to RCTs demonstrated no significant effect of antibiotics on initial treatment success (RR: 1.03, 95% CI: 0.92-1.15). Analysis across three studies showed no significant differences in recurrence (RR: 1.38, 95% CI: 0.68-2.80) or the need for…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 437 participants or records.
Read the paper
Related studies
- Ferulic acid regulates the AKT/GSK-3β/CRMP-2 signaling pathway in a middle cerebral artery occlusion animal model
- Novel Pharmacokinetic/Pharmacodynamic Parameters Quantify the Exposure–Effect Relationship of Levofloxacin against Fluoroquinolone-Resistant Escherichia coli
- Photochemical behavior of levofloxacin
- Correlation Between Dissolution Profiles of Salt-Form Drugs in Biorelevant Bicarbonate Buffer and Oral Drug Absorption: Importance of Dose/ Fluid Volume Ratio
- Evaluation of the synergistic potential and mechanisms of action for de novo designed cationic antimicrobial peptides
- Synthesis of [11C]levofloxacin
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.