SKENARIO :

Seorang remaja bernama Gema berusia 16 tahun mengalami sakit perut, terutama
dimulai di sekitar pusar dan bergerak ke perut kanan bawah, nafsu makannya menurun,
disertai mual. Gema juga mengeluhkan demam. Demam yang dirasakannya sepanjang hari.
Sehingga Gema dibawa ke Rumah Sakit untuk diperiksa oleh dokter. Dokter melakukan
pemeriksaan lebih lanjut, lalu dokter mendiagnosis bahwa Gema menderita appendicitis
(infeksi usus buntu). Kemudian disarankan untuk minum percutaneous drainage dengan
antibiotics daripada antibiotics saja.

BACKGROUND QUESTION :

1. Bagaimana cara kerja dari percutaneous drainage dengan antibiotics?

2. Apa saja kriteria atau ciri-ciri dari penyakit appendicitis?
3. Apa saja isi kandungan dari percutaneous drainage?

FOREGROUND QUESTION :

Apakah penggunaan percutaneous drainage dengan antibiotics lebih efektif daripada

antibiotics saja untuk kasus appendicitis?

PICO :

Patient : Pasien penderita apendicitis

Intervention : Percutaneous drainage and antibiotics
Comparison : Antibiotics
Outcome : Lebih efektif dalam mengatasi infeksi

TYPE OF QUESTION : Therapy

TYPE OF STUDY : Clinical Trial

PEMILIHAN SITUS : Web.ebscohost.com

KATA KUNCI : Appendicitis AND effectiveness AND percutaneous drainage

AND antibiotics

LIMITASI : 10 tahun terakhir

HASIL PENCARIAN : 1 artikel

JUDUL HASIL PENCARIAN: Comparison of therapeutic effectiveness of percutaneous

drainage with antibiotics versus antibiotics alone in the
treatment of periappendiceal abscess: is appendectomy always
necessary after perforation of appendix?
Artikel yang dipilih : Zerem E, et al., (2007) Comparison of therapeutic effectiveness of
percutaneous drainage with antibiotics versus antibiotics alone in the treatment of
periappendiceal abscess: is appendectomy always necessary after perforation of appendix?,
Surgical Endoscopy. 21(3); 461-466.

Comparison of therapeutic effectiveness of percutaneous drainage with antibiotics

versus antibiotics alone in the treatment of periappendiceal abscess: is appendectomy
always necessary after perforation of appendix?

Authors:
Zerem E ; Salkic N ; Imamovic G ; Terzi I
Author Address:
Interventional Ultrasonography Department, University Clinical Center Tuzla, Izeta
Sarajlia B/6, Slavinovici-Luke, Tuzla, Bosnia and Herzegovina. zerem@inet.ba
Source:
Surgical Endoscopy [Surg Endosc] 2007 Mar; Vol. 21 (3), pp. 461-6. Date of
Electronic Publication: 2006 Nov 14.
Publication Type:
Comparative Study; Journal Article; Randomized Controlled Trial
Language:
English
Journal Info:
Publisher: Springer Country of Publication: Germany NLM ID: 8806653 Publication
Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2218 (Electronic)
Linking ISSN: 09302794 NLM ISO Abbreviation: Surg Endosc Subsets: MEDLINE
Imprint Name(s):
Publication: 1992- : New York : Springer
Original Publication: [Berlin] : Springer International, c1987-
MeSH Terms:
Abscess/*therapy
Anti-Bacterial Agents/*therapeutic use
Appendicitis/*therapy
Abscess/ultrasonography ; Adult ; Ampicillin/therapeutic
use ; Appendectomy ; Appendicitis/ultrasonography ; Cefuroxime/therapeutic
use ; Combined Modality Therapy/methods ; Drainage/methods ; Drug Therapy,
Combination ; Female ; Follow-Up Studies ; Humans ; Length of
Stay ; Male ; Metronidazole/therapeutic use ; Prospective Studies ; Treatment
Outcome
Abstract:
Background: The present study was designed to compare the therapeutic
effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the
treatment of appendicitis complicated by periappendiceal abscess.
Methods: In a prospective study, 50 patients with acute appendicitis complicated by
periappendiceal abscess > or = 3 cm in size were randomly assigned to two groups.
The first group received treatment with ultrasound guided-percutaneous drainage and
i.v. antibiotics (ampicillin, cefuroxime, and metronidazole), and the other group
received antibiotics only. Patient's baseline characteristics, duration of hospital stay,
and treatment outcome and complications were analyzed.
Results: Appendectomy was avoided in 16/25 patients in the drainage group and 2/25
patients in the non-drainage group during follow-up with RR of 0.39 (95% CI = 0.22-
 0.62; p < 0.05). One patient in the drainage group and 8 patients in the non-
drainage group underwent surgery in the first month after the beginning of treatment.
Eight patients in the drainage group and 15 in the non-drainage group underwent
interval appendectomy. There was no statistically significant difference between the
two groups regarding patient demographics, abscess size, and pretreatment clinical
symptoms. Hospital stay up to the subsidence of clinical and sonographic signs was
significantly shorter (p < 0.001) in the drainage group, with a mean difference of
6.4 days (95% CI = 5.0-7.9; p < 0.05).
Conclusions: Percutaneous drainage with antibiotics is a safe and effective way of
treating acute perforated appendicitis. The recurrence rate for these patients is
relatively low, and very often interval appendectomy is not required. For patients with
periappendiceal abscess > or = 3 cm in diameter, antibiotic therapy alone is
insufficient and the recurrence rate is high.
Substance Nomenclature:
0 (Anti-Bacterial Agents)
443-48-1 (Metronidazole)
55268-75-2 (Cefuroxime)
69-53-4 (Ampicillin)
Entry Date(s):
Date Created: 20070223 Date Completed: 20070423
Update Code:
20121129
PMID:
17103286
Database:
MEDLINE Complete