Most all of us probably think that if we or someone we know gets appendicitis, that the appendix must be removed, and usually quickly. But that surgical procedure, which has been the standard of treatment for over 100 years, has been recently called into question. More doctors are saying that most cases of uncomplicated appendicitis can be successfully treated with antibiotics instead of surgery.
The most recent study, coming out of Finland, was published in the Journal of the American Medical Association. The researchers studied 530 patients aged 18 through 60 who presented with uncomplicated appendicitis. They randomly divided the patients into two groups: half were treated with surgery, and the other half were treated with antibiotics and no surgery.
The patients treated with antibiotics received 3 days of intravenous antibiotics in the hospital, and then they were sent home with an additional week of oral antibiotic pills. Basically all the patients who underwent surgery were cured, and about 75% of those who received the antibiotics were cured with antibiotics alone, and did not need surgery. The 25% of people not cured with the antibiotics alone underwent surgery to successfully cure them.
The authors of the study note that if a patient comes in with “complicated” appendicitis, that they should have surgery right away, and not only antibiotics. “Complicated” appendicitis includes cases where the appendix has ruptured, or there is an abscess in the abdomen from the infection, or they have a hard stone (called a appendicolith) blocking the appendix.
Whenever there is a suspicion of appendicitis, a CT scan should be done to confirm the diagnosis and to see if the appendicitis is complicated. If appendicitis is confirmed, and there is no complication, this Finnish study suggests that antibiotics would be a reasonable alternative to surgery.
There are some surgeons though that disagree with this position, and believe that even if the person is seemingly cured with antibiotics, that they are more likely than the average person to suffer a recurrence of appendicitis in the future, so that perhaps the patient is better served—in the long run—by just having the surgery so they don’t have to worry about the problems again.
Appendicitis will strike about 10% of adults at some point in their lives, so many of us will have to consider this question for ourselves. If this happens, you should probably discuss the option of antibiotics alone, without surgery, with your doctor.
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