Surgical procedure or Antibiotics for Appendicitis?

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Surgery or Antibiotics for Appendicitis?

It used to be that almost everyone had their appendix removed in childhood. It was almost a rite of passage. "(A) pendectomy is one of the most common abdominal surgeries in the world," wrote Dr. Christopher J. Burns on the Harvard Health Blog. "It is also the most common general emergency surgery in the US."

However, in some situations, doctors first treat appendicitis with antibiotics in hopes of avoiding surgery. While surgery is very common and well tolerated by the patient, any type of operation largely carries the risk of complications, including infections. And recovery takes the patient away from work or school for at least a few days, if not longer.

Do antibiotics work for appendicitis?

In 2015, a study examining the benefits of antibiotics for appendicitis received a lot of medical attention. The researchers found that most patients who received antibiotics for appendicitis that weren't complicated by a rupture or abscess recovered and didn't need surgery for up to a year later. Patients who underwent surgery did not experience significant complications, wrote Dr. Burns.

New research, published in the New England Journal of Medicine, compared the results of patients with appendicitis who had appendicectomy with those who took antibiotics. The researchers found that while the medical route of treatment was effective for some patients, it was not for all.

"Both treatments had pros and cons, and patients are likely to prioritize them differently based on their own unique characteristics and interests," said Dr. F. Thurston Drake in a press release. Dr. Drake is a general and endocrine surgeon at Boston Medical Center (BMC). He served as the co-site director for the study.

The study

25 medical centers participated in the study, which enrolled over 1,500 patients with appendicitis. Half received antibiotic therapy and 47% of them stayed at home to start treatment. The other half were operated on – 96% were operated on laparoscopically. This is a minimally invasive surgery that uses only a tiny incision.

After 3 months, the researchers found that a little less than a third of the patients in the antibiotic group had surgery anyway. The antibiotic group also had more complications during treatment. "People treated with antibiotics were more likely to return to the emergency room, but missed less time from work and school," said Bonnie Bizzell, chair of the Antibiotic and Appendectomy (CODA) patient advisory council.

Other notable results were:

Both groups of patients had symptoms of appendicitis for the same period of time

  • Symptoms of appendicitis had about the same length of time in patients treated with either surgery or antibiotics.
  • Approximately 3 out of 10 patients in the antibiotic group underwent appendectomy after 90 days.
  • Complications were twice as likely in patients with an appendix, a calcified deposit in the appendix, which increased the likelihood of surgery.

Take them home

Appendicitis doesn't always mean surgery. Depending on the situation, antibiotics can be the right treatment. However, antibiotic treatment does not guarantee that surgery will not be necessary later. If you or someone you care for has appendicitis, speak to your doctor to determine the correct course of action.

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