Antibiotics for appendicitis? Study Reveals Surgery Often Not Necessary

CHICAGO – When emergency tests showed that appendicitis was a revealing pain on the right side of Heather VanDusen's abdomen, she thought that she was going to be quickly operated on. But the doctors offered him the option of antibiotics instead.

A new study from Finland shows that his choice is a reasonable alternative for most patients with appendicitis. Five years after antibiotic treatment, nearly two-thirds of patients had not had another attack.

This is a substantial change in the way of treating an inflamed appendix. For decades, appendicitis has been considered a medical emergency requiring immediate surgery to remove the appendix because of fears that it could burst, which can put its life at risk.

But advances in imaging tests, mainly CT, have made it easier to determine if an appendix could burst or if patients could be treated without surgery.

The results suggest that nearly two-thirds of appendicitis patients do not run this risk and may be good candidates for antibiotics instead.

"This is a feasible, viable and safe option," said Dr. Paulina Salminen, lead author of the study and surgeon at the Turku University Hospital in Finland.

His study in the adult is the longest follow-up to date of drug-treated patients instead of appendicitis surgery and the results confirm the one-year results reported three years ago.

Research has also shown that antibiotics can work in some children with appendicitis.

The Finnish results were published Tuesday in the Journal of the American Medical Association.

A newspaper editorial says "it's a new era of appendicitis treatment".

The removal of the appendix is ​​the most prevalent emergency surgery in the world, with approximately 300,000 people executed each year in the United States alone, said Salminen. She said the results of her study suggest that many of these surgeries could be avoided.

US doctors have started offering antibiotics instead of surgery and Salminen says she sometimes does. The editorial of the journal states that appropriate patients should receive this option.

The study involved about 500 Finnish adults who had CT to eliminate serious cases.

Half were treated with antibiotics; the others were operated on.

Of the patients treated with antibiotics, 100 were operated on within five years of treatment, most often for a relapse of appendicitis in the first year. Seven of them had no appendicitis and probably could have avoided surgery. The results suggest that the success rate of antibiotic treatment was close to 64%, according to the authors.

About 1 in 4 surgical patients had complications, including infections around the incision, abdominal pain and hernias, compared to only 7% of patients on antibiotics. Antibiotic patients had an average of 11 fewer days off than the surgical group. In the first year, treatment costs were about 60% lower. A cost analysis for the full five years was not included in the published results.

Patients in surgery in the Finnish study all had conventional incisions rather than less invasive "keyhole" surgeries that are more common for the elimination of the appendix in the United States. Nonsurgical patients received three days of IV antibiotics at the hospital, followed by seven days of pills at home.

Dr. Giana Davidson, a surgeon at the University of Washington, is involved in a similarly designed American multicenter study that could determine whether similar benefits would be seen for antibiotics over "keyhole" surgery.

Davidson called the Finnish study a "critical piece of the puzzle but I do not think she answers all the questions".

Heather VanDusen was cared for at the University of Washington in 2016. She said she chose an antibiotic treatment in part to avoid surgical scars, and now offers patient counseling for the Davidson study.

"I knew the worst case scenario was in the hospital, so why not try antibiotics first?" Said VanDusen, who works in academic communications.

She said that she has done well since her treatment, but that the biggest disadvantage "is to wonder, at each episode of stomach or bad gas, if that can happen again."