What are the current guidelines for the management of uncomplicated acute appendicitis in primary care?

Management of uncomplicated acute appendicitis in primary care:

• If acute appendicitis is suspected, arrange emergency hospital admission for specialist assessment and management, especially if complications are suspected or the patient is pregnant, elderly, or a child.
• If there is a low index of suspicion of acute appendicitis at initial presentation and immediate hospital admission is not necessary, consider additional investigations in primary care to exclude alternative diagnoses based on clinical judgement.
• Advise the patient or parents on symptoms to monitor and when to seek urgent medical review, providing safety-netting advice such as the NHS leaflet on appendicitis.
• Non-operative management with intravenous fluids and antibiotics may be considered only after negative imaging and in selected patients with uncomplicated appendicitis, but this is typically managed in secondary care.
• Operative management (appendicectomy) remains the gold standard treatment for uncomplicated appendicitis and is performed in hospital settings.

In summary, primary care's role is to promptly identify suspected appendicitis, arrange emergency hospital admission for specialist care, or if suspicion is low, to consider further investigations and provide safety-netting advice. Definitive treatment is hospital-based.

References: NICE CKS