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According to a study in Finland, most uncomplicated acute appendicitis can be treated with antibiotics and does not require surgery. This treatment has tipped the standard treatment against very common, painful and potentially fatal abdominal infection.
The use of antibiotics alone has helped treat three out of five uncomplicated patients, with only 39.1% of patients initially treated with antibiotics alone requiring surgery over the next five years. Five-year observational monitoring of 257 patients aged 18 to 60 in Finland.
"This long-term follow-up confirms the feasibility of antibiotic therapy alone as an" alternative to surgery for uncomplicated acute appendicitis, "said the authors of the study published in JAMA, the Journal of the American Medical Association.
The appendix is a finger-shaped pocket in the colon located in the lower right abdomen. Once considered a useless, vestigial and expendable organ, the appendix has recently been identified as a reservoir of "good" beneficial intestinal bacteria, which help the digestive system recover from bouts of diarrhea and other gastrointestinal diseases. .
For more than a century, surgery has been the gold standard for appendicitis, ie inflammation of the appendix due to acute infection and causing symptoms. sudden and severe pain at the bottom of the abdomen, nausea, vomiting and abdominal bloating. Uncomplicated appendicitis is an infection without complications such as perforation, abscess or tumor suspicion.
Medications first
Antibiotic treatment resulted in fewer complications and a faster recovery, the group taking antibiotics took an average of 11 days of sick leave to recover, compared with 22 days for patients undergoing surgery. Antibiotics also reduced the complication rate to 6.5%, up from 24% after surgery, mainly as a result of infections.
Although the study did not compare costs, patients who do not undergo an operation spend less on treatment, especially for the treatment of surgical complications.
On average, the operated patients remained in the hospital for three days, while those treated with antibiotics received three days of intravenous drugs at the hospital, followed by a week of prescribing. Oral antibiotics after their release. The antibiotics used were intravenous eryapenem for three days, followed by seven days of oral levofloxacin and metronidazole, all broad-spectrum antibiotics acting against a wide range of pathogenic bacteria.
An important finding was that none of the patients in the group of antibiotics who ultimately needed an operation had complications related to a delay in surgery. "Although patients may be concerned about the ultimate need for surgery from a health outcome point of view, nonsurgical treatment in simple appendicitis before surgery is a reasonable option. ", explained an accompanying editorial in JAMA.
Good price
The findings of the study are not totally surprising and constitute a long-term follow-up of 2015 pertaining to appendicitis appenduta (APPAC), which compared the results of open appendectomy (removal of the Appendix) with antibiotic treatment for uncomplicated acute appendicitis and declared antibiotic declaration was a reasonable alternative. to surgery. Of the 257 patients in the antibiotic group, 186 (73%) initially treated with antibiotics did not require surgery after one year, but concerns were expressed about whether antibiotics temporarily improved the situation and whether the initial drug treatment left the patients if they finally needed a surgical procedure.
Despite evidence of the efficacy of antibiotics, expert groups have recommended that APPAC results can not be used for clinical decision-making as long-term results do not occur. were not known to patients treated with antibiotics, which was provided by the small study.
These results have great implications in places, such as many rural areas of India, where surgeons are not available 24 hours a day and 4 days out of 4 for emergency surgeries. Further research must now identify the best treatment for appendicitis compared to minimally invasive laparoscopic surgery, which replaces conventional open surgery in most parts of the world, including India.
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First publication: September 30, 2018 at 11:56 am IST
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