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CHICAGO – When emergency tests showed that appendicitis was due to acute pain in Heather VanDusen's abdomen, she thought she would soon be brought to surgery. But the doctors offered him the option of antibiotics instead.
A new study in 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 a new attack.
This is an important change in how to treat 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 about two-thirds of patients with appendicitis are not at risk and may be good candidates for antibiotics.
"This is a feasible, viable and safe option," said Dr. Paulina Salminen, lead author of the study and surgeon at 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.
An editorial of the journal says "This is a new era of treatment for appendicitis".
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 scans to eliminate severe 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.
Surgery patients in the Finnish study all had conventional incisions rather than less invasive "keyhole" surgeries that are more common for withdrawal from 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 US multi-center study that could determine whether similar benefits would be seen for antibiotics compared to lock".
Davidson called the Finnish study a "critical piece of the puzzle, but I do not think it 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 operation scars, and now offers advice to patients 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 drawback is "wondering, at each episode of stomach or bad gas, if that can happen again."
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