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Background: Acute appendicitis remains the most common cause of the acute abdomen in young adults, and the mainstay of treatment in most centres is an appendectomy. However, treatment for other intra-abdominal inflammatory processes, such as diverticulitis, consists initially of conservative management with antibiotics. The aim of this study was to determine the role of antibiotics in the management of acute appendicitis and to assess if appendectomy remains the gold standard of care. Methods: A literature search using MEDLINE and the Cochrane Library identified studies published between 1999 and 2009, and we reviewed all relevant articles. The articles were critiqued using the Public Health Resource Unit (2006) appraisal tools. Results: Our search yielded 41 papers, and we identified a total of 13 papers within the criteria specified. All of these papers, while posing pertinent questions and demonstrating the role of antibiotics as a bridge to surgery, failed to adequately justify their findings that antibiotics could be used as a definitive treatment of acute appendicitis. Conclusion: Appendectomy remains the gold standard of treatment for acute appendicitis based on the current evidence. Contexte : L'appendicite aigue demeure la plus frequente cause de l'abdomen aigu chez les jeunes adultes et dans la plupart des centres, la base du traitement repose sur l'appendicectomie. Toutefois, le traitement des autres processus inflammatoires intra-abdominaux, comme la diverticulite, consiste initialement en une prise en charge conservatrice par antibiotherapie. Cette etude avait pour but de determiner le role des antibiotiques dans la prise en charge de l'appendicite aigue et de verifier si l'appendicectomie reste la norme therapeutique. Methodes : Une interrogation des publications dans MEDLINE et la Collaboration Cochrane a permis de recenser des etudes publiees entre 1999 et 2009 et nous avons passe en revue tous les articles pertinents. Nous avons soumis les articles a un examen critique en appliquant les outils d'evaluation de la Public Health Resource Unit (2006). Resultats : Notre recherche a retrouve 41 articles, et nous avons retenu 13 articles a partir des criteres specifies. Tous, meme s'ils posaient des questions pertinentes et etablissaient le role de l'antibiotherapie comme etape de transition avant la chirurgie, ont echoue a demontrer de facon adequate leurs conclusions selon lesquelles les antibiotiques pourraient etre utilises en traitement definitif de l'appendicite aigue. Conclusion : Si l'on se fie aux preuves actuelles, l'appendicectomie reste la norme therapeutique privilegiee pour le traitement de l'appendice aigue., Acute appendicitis is inflammation of the vermiform appendix and remains the most common cause of the acute abdomen in young adults. The mainstay of treatment in most centres is an [...]

A response by Andrea Cariati and colleagues to a letter to the editor about their article related to the management of acute appendicitis which was published in a previous issue is presented.