Patients with appendicitis usually have surgery to remove their appendix, but in some cases, it may be safe to use antibiotics as a first-line treatment instead, a new study suggests.
In the study, patients treated with antibiotics were at no increased risk of their appendix bursting compared to those who underwent surgery, and were 31 percent less likely to experience complications, such as wound infection, the researchers said.
"The role of antibiotic treatment in acute, uncomplicated appendicitis may have been overlooked mainly on the basis of tradition, rather than evidence," the researchers wrote today in the British Medical Journal. Using antibiotics in these cases, along with reassessing the patient, "will prevent the need for the most appendectomies," they said.
However, patients with complicated appendicitis — in which the appendix has burst, or the lining of the abdominal cavity is swollen and infected — should still be treated with surgery, the researchers say.
Other experts argue not doing surgery has major disadvantages, and more evidence is needed before antibiotics are used to treat uncomplicated appendicitis.
Surgery to remove an inflamed appendix, or appendicectomy, has been the mainstay of treatment for acute appendicitis since 1889, the researchers said. The general assumption is that, without surgery, the risk of complications, such as perforation or infection, is high.
Recent studies have reported fewer problems with antibiotic therapy than surgery in patients with uncomplicated appendicitis, but results have been inconclusive, and some of these studies have been retracted by the researchers.
In the new study, researchers from the University of Nottingham in the United Kingdom analyzed the results of four trials involving 900 adult patients diagnosed with uncomplicated acute appendicitis in which patients were randomly assigned to receive antibiotics or surgery. A total of 470 patients received antibiotics, and 430 underwent surgery.
Even after excluding patients from one study who started on antibiotics but later required surgery, antibiotic therapy was associated with a 39 percent reduction in complications, compared with surgery.
However, 20 percent of patients in the study who were initially treated with antibiotics experienced reoccurrence of their appendicitis, Dr. Olaf Bakker, of the University Medical Center Utrecht in The Netherlands, said in an editorial accompanying the study.
Until more convincing and longer term results are published, "appendectomy for uncomplicated appendicitis will probably continue," Bakker said.
Pass it on: Antibiotics may be a safe initial treatment for appendicitis.