Antibiotics Could Be Sufficient for Treating Appendicitis

For uncomplicated appendicitis, using antibiotics first may preclude the need to remove the appendix and reduce complications, according to a new study.

Researchers at Nottingham University Hospitals (United Kingdom) conducted a meta-analysis of four randomized controlled trials with a total of 900 adult patients presenting with uncomplicated acute appendicitis, as diagnosed by hematological and radiological investigations. In all, 470 patients treated with antibiotics were compared to 430 patients that underwent appendectomy to examine the safety, complications, and efficacy of treatment, length of stay, and incidence of complicated appendicitis and readmissions.

The results showed that antibiotic treatment was associated with a 63% success rate at one year, and initial use of antibiotics was associated with a significant reduction in complications, even after excluding the fact that 20% of the patients crossed over to the appendectomy group within one year, and that of those, nine had perforated appendicitis and four had gangrenous disease. In all, the meta-analysis showed a relative risk reduction for complications of 31% for antibiotic treatment, with the overall risk of perforated or gangrenous appendicitis in the antibiotic group at 7.4%. No significant differences were seen for treatment efficacy, length of stay, or risk of developing complicated appendicitis. The study was published on April 5, 2012, in BMJ.

“Given the increase in nonperforated appendicitis diagnosed with more frequent use of computed tomography and laparoscopy, a careful 'wait, watch, and treat' policy may be adopted in those patients considered to have uncomplicated appendicitis or in whom the diagnosis is uncertain, as in these patients correct diagnosis rather than an early appendectomy is the key,” concluded lead author Prof. Dileep Lobo, MD, and colleagues of the division of gastrointestinal surgery.

Appendectomy is the surgical removal of the vermiform appendix. It is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis. In the absence of surgical facilities, intravenous antibiotics are used to delay or avoid the onset of sepsis. In some cases, the appendicitis resolves completely; more often, an inflammatory mass forms around the appendix, causing transruptural flotation.

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