APPENDECTOMY OR CONSERVATIVE TREATMENT? A CURRENT REVIEW OF THE EVIDENCE IN THE MANAGEMENT OF ACUTE APPENDICITIS

Abstract

Acute appendicitis remains one of the leading causes of acute abdomen in adults, and appendectomy has historically been established as the standard treatment. However, recent scientific evidence has shown that antibiotic therapy may represent a viable therapeutic alternative in selected cases of uncomplicated acute appendicitis. In this context, the present study aimed to critically analyze the available evidence on the use of antibiotics in the management of acute appendicitis, discussing their efficacy, limitations, and indication criteria. To this end, a literature review was conducted based on clinical studies, randomized clinical trials, and meta-analyses that compared conservative management with antibiotic therapy to traditional surgical treatment. The results indicate that conservative treatment can promote initial clinical resolution in a significant portion of patients, avoiding the need for immediate surgical intervention in more than 70% of cases during the first year of follow-up. However, some patients may present initial therapeutic failure or recurrence of the disease during clinical follow-up. Thus, antibiotic therapy can be considered a safe alternative in carefully selected patients with uncomplicated appendicitis, provided that there is adequate diagnostic confirmation and appropriate clinical follow-up, contributing to a more individualized and evidence-based therapeutic approach.