Antibiotics a safe and viable alternative to surgery for uncomplicated appendicitis, say experts
Giving antibiotics to patients with acute uncomplicated appendicitis is a safe and viable alternative to surgery, say experts in a study published in the British Medical Journal today.
Surgery to remove an inflamed appendix (appendicectomy) has been the mainstay of treatment for acute appendicitis since 1889 and the general assumption is that, without surgery, the risk of complications, such as perforation or infection, is high.
However, recent studies have reported fewer problems with antibiotic therapy than surgery in patients with uncomplicated appendicitis, but results have been inconclusive.
So a team of researchers at the Nottingham Digestive Diseaeses Centre NIHR Biomedical Research Unit set out to compare the safety and efficacy of antibiotic therapy as an initial treatment for uncomplicated acute appendicitis.
They analysed the results of four randomised controlled trials involving 900 adult patients diagnosed with uncomplicated acute appendicitis. A total of 470 patients received antibiotics and 430 underwent surgery.
Differences in study design and quality were taken into account to minimise bias.
Antibiotic therapy was associated with a 63% success rate at one year and a 31% relative reduction in complications compared with surgery.
Even after excluding patients from one study who crossed over from the antibiotic group to the surgery group, a significant (39%) reduction in complications with antibiotic therapy compared with surgery remained.
Of 68 patients treated with antibiotics who were readmitted with recurrence of symptoms, four had normal appendix and 13 had complicated appendicitis. Three patients were treated successfully with another course of antibiotics.
There were no significant differences in either length of hospital stay or risk of developing complicated appendicitis between the two groups of patients.
The authors argue that the role of antibiotics in acute uncomplicated appendicitis "has been overlooked based mainly on tradition rather than evidence" and they suggest that a careful 'wait, watch and treat' policy may be adopted in patients considered to have uncomplicated appendicitis or in whom the diagnosis is uncertain.
However, they stress that for those with clear signs of perforation or peritonitis (inflammation of the abdominal wall) early appendicectomy still remains the 'gold standard.'
They conclude that antibiotic therapy "is a safe initial therapy for patients with uncomplicated acute appendicitis" and that it "merits consideration as a primary treatment option for early uncomplicated appendicitis."
In an accompanying editorial, Dr Olaf Bakker from the Department of Surgery at the University Medical Center Utrecht in the Netherlands argues that treating appendicitis conservatively has "major certain disadvantages" as the reoccurrence rate of appendicitis is up to 20% in the first year. He argues that until more convincing and longer term results are published, "appendectomy for uncomplicated appendicitis will probably continue."
Journal reference: British Medical Journal (BMJ)
Provided by British Medical Journal
- Treating acute appendicitis with antibiotics not as effective as having appendix removed May 05, 2011 | not rated yet | 0
- Treating appendicitis by laparoscopic surgery may not be worth the cost Feb 03, 2009 | not rated yet | 0
- Appendectomy may be best for patients with positive CT exam May 26, 2010 | not rated yet | 0
- Ultrasound first, not CT, for diagnosing suspected acute appendicitis May 07, 2008 | not rated yet | 0
- Air pollution may increase risk of appendicitis Oct 06, 2008 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
Clinical measurement of physical activity appears to be an independent predictor of whether or not patients with chronic obstructive pulmonary disease (COPD) will end up being hospitalized, according to a new study conducted ...
Diseases, Conditions, Syndromes 1 hour ago | not rated yet | 0
A novel approach to obstructing the runaway inflammatory response implicated in some types of asthma has shown promise in a Phase IIa clinical trial, according to U. S. researchers.
Diseases, Conditions, Syndromes 2 hours ago | not rated yet | 0
Extended use of a common antibiotic may prolong the time between hospitalizations for patients suffering from chronic obstructive pulmonary disease (COPD), according to a post-hoc analysis of a multicenter study which compared ...
Diseases, Conditions, Syndromes 2 hours ago | not rated yet | 0
(HealthDay)—Obese and overweight men and women who suffer from heartburn often report relief when they lose weight, a new study shows.
Diseases, Conditions, Syndromes 3 hours ago | not rated yet | 0 |
(AP)—A 66-year-old Tunisian man has died from the new coronavirus following a visit to Saudi Arabia and two of his adult children were infected with it, the Tunisian Health Ministry reported.
Diseases, Conditions, Syndromes 4 hours ago | not rated yet | 0
(Medical Xpress)—Native peoples in regions where cameras are uncommon sometimes react with caution when their picture is taken. The fear that something must have been stolen from them to create the photo ...
13 minutes ago | not rated yet | 0 |
In a remote fishing community in Venezuela, a lone fisherman sits on a cliff overlooking the southern Caribbean Sea. This man –– the lookout –– is responsible for directing his comrades on the water, ...
2 hours ago | not rated yet | 0 |
(Medical Xpress)—A research team, led by Jeremy Barr, a biology post-doctoral fellow, unveils a new immune system that protects humans and animals from infection.
16 hours ago | 4.7 / 5 (16) | 7 |
Johns Hopkins researchers say they have discovered specific chemical alterations in two genes that, when present during pregnancy, reliably predict whether a woman will develop postpartum depression.
7 hours ago | not rated yet | 0 |
Authorities are investigating rice mills in southern China following tests that found almost half of the staple grain in one of the country's largest cities was contaminated with a toxic metal.
2 hours ago | 5 / 5 (1) | 0
Delayed transfer to the intensive care unit (ICU) in hospitalized patients significantly increases the risk of dying in the hospital, according to a new study from researchers in Chicago.
1 hour ago | not rated yet | 0