Antibiotics could replace surgery for appendicitis

Although the standard approach to acute appendicitis is to remove the appendix, a study at the Sahlgrenska Academy, University of Gothenburg, Sweden, reveals that treatment with antibiotics can be just as effective in many cases.

In her thesis, Jeanette Hansson discusses two major clinical studies of adult patients with acute appendicitis. In the first study she compares surgery with antibiotic therapy, while in the second patients with appendicitis were treated with antibiotics as first-line therapy.

Carried out at Sahlgrenska University Hospital and Kungälv Hospital, the studies showed that treatment with antibiotics was just as effective as surgery for the majority of patients. "Some patients are so ill that the operation is absolutely necessary, but 80 percent of those who can be treated with antibiotics recover and return to full health," says Jeanette Hansson.

The thesis also shows that patients who are treated with antibiotics are at risk of fewer complications than those who undergo surgery.

The risk of recurrence within 12 months of treatment with antibiotics is around 10-15 percent. Jeanette Hansson and her colleagues hope to be able to document the risk of recurrence over the long term and also to study whether recurrences can also be treated with antibiotics. Even though increased resistance to antibiotics could also affect the treatment, the conclusion is that antibiotics are a viable alternative to surgery in adult patients as things stand, provided that the patient accepts the risk of recurrence.

"It's important to note that our studies show that patients who need surgery because of recurrences, or because the antibiotics haven't worked, are not at risk of any additional complications relative to those operated on in the first place," says Jeanette Hansson.