Antibiotics a safe and viable alternative to surgery for uncomplicated appendicitis, say experts

April 5, 2012

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 (appendicectomy) has been the mainstay of treatment for since 1889 and the general assumption is that, without surgery, the risk of complications, such as or infection, is high.

However, recent studies have reported fewer problems with than surgery in patients with uncomplicated appendicitis, but results have been inconclusive.

So a team of researchers at the Nottingham Digestive Diseaeses Centre NIHR 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 involving 900 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."

Explore further: Treating acute appendicitis with antibiotics not as effective as having appendix removed

Related Stories

Treating acute appendicitis with antibiotics not as effective as having appendix removed

May 5, 2011
Treating acute appendicitis with antibiotics is not as effective as the gold standard treatment of having the appendix surgically removed (appendicectomy). This is the conclusion of an Article in this week's edition of The ...

Recommended for you

Study seeks to aid diagnosis, management of catatonia

December 11, 2017
Catatonia, a syndrome of motor, emotional and behavioral abnormalities frequently characterized by muscular rigidity and a trance-like mental stupor and at times manifesting with great excitement or agitation, can occur during ...

New compound stops progressive kidney disease in its tracks

December 7, 2017
Progressive kidney diseases, whether caused by obesity, hypertension, diabetes, or rare genetic mutations, often have the same outcome: The cells responsible for filtering the blood are destroyed. Reporting today in Science, ...

New Lyme disease tests could offer quicker, more accurate detection

December 7, 2017
New tests to detect early Lyme disease - which is increasing beyond the summer months -could replace existing tests that often do not clearly identify the infection before health problems occur.

Spinal tap needle type impacts the risk of complications

December 6, 2017
The type of needle used during a lumbar puncture makes a significant difference in the subsequent occurrence of headache, nerve irritation and hearing disturbance in patients, according to a study by Hamilton medical researchers.

Men with HPV are 20 times more likely to be reinfected after one year

December 5, 2017
A new analysis of genital human papillomavirus (HPV) in men shows that infection with one HPV type strongly increases the risk of reinfection with the same type. In fact, men who are infected with the type responsible for ...

New tuberculosis drugs possible with understanding of old antibiotic

December 5, 2017
Tuberculosis, and other life-threatening microbial diseases, could be more effectively tackled with future drugs, thanks to new research into an old antibiotic by the University of Warwick and The Francis Crick Institute.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.