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

Decrease in sunshine, increase in Rickets

November 17, 2017
A University of Toronto student and professor have teamed up to discover that Britain's increasing cloudiness during the summer could be an important reason for the mysterious increase in Rickets among British children over ...

Anti-malaria drug shows promise as Zika virus treatment

November 17, 2017
A new collaborative study led by researchers at Sanford Burnham Prebys Medical Discovery Institute (SBP) and UC San Diego School of Medicine has found that a medication used to prevent and treat malaria may also be effective ...

Scientists identify biomarkers that indicate likelihood of survival in infected patients

November 17, 2017
Scientists have identified a set of biomarkers that indicate which patients infected with the Ebola virus are most at risk of dying from the disease.

Research team unlocks secrets of Ebola

November 16, 2017
In a comprehensive and complex molecular study of blood samples from Ebola patients in Sierra Leone, published today (Nov. 16, 2017) in Cell Host and Microbe, a scientific team led by the University of Wisconsin-Madison has ...

Study raises possibility of naturally acquired immunity against Zika virus

November 16, 2017
Birth defects in babies born infected with Zika virus remain a major health concern. Now, scientists suggest the possibility that some women in high-risk Zika regions may already be protected and not know it.

A structural clue to attacking malaria's 'Achilles heel'

November 16, 2017
Researchers from The Scripps Research Institute (TSRI) and PATH's Malaria Vaccine Initiative (MVI) have shed light on how the human immune system recognizes the malaria parasite though investigation of antibodies generated ...

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.