Severe appendicitis has been treated as a medical emergency for nearly 130 years. A person comes in with pain in their lower abdomen along with fever and the next step was to remove the infected appendix. But a study has found that most patients can be treated with antibiotics alone.
The study was conducted in Finland and published in the Journal of the American Medical Association. The study was a large one, involving 520 people with uncomplicated appendicitis who agreed to let the choice of whether to be treated with antibiotics or with surgery be made randomly.
The patients who were treated with antibiotics received one dose of an intravenous antibiotic and then two oral antibiotics for a week. The rest were treated with a standard open appendectomy surgery. Patients were screened with CT imaging to eliminate the complicated cases, such as where the appendix had burst or where an abdominal abscess or blockage had occurred. These complications occurred in about 20% of the patients who had symptoms of appendicitis and who were not then included in the study.
The study found that all but one of the patients assigned to have an appendectomy had successful surgery, which is a success rate of more than 99%. About 73% of the patients who were treated with antibiotics recovered with no problems. Seventy patients, or a bit over 27%, of those treated with antibiotics needed to have an appendectomy within a year of first seeing a doctor with symptoms of appendicitis. Of these patients, 58 had uncomplicated appendicitis, 7 were complicated cases, and 5 did not have appendicitis but had the surgery because of the suspicious recurrence of symptoms.
"The time has come to consider abandoning routine appendectomy for patients with uncomplicated appendicitis," Dr. Edward H. Livingston, a surgeon and editor at the journal, said in an editorial in the same issue as the study. Livingston noted that most appendixes that perforate were perforated when the patient arrived at the emergency room. Appendixes that have not perforated by that time do not appear to perforate later, he said.
There has been some questioning of whether the routine use of surgery for uncomplicated appendicitis is needed. This study will need to be followed up with further studies to better determine the safety of using antibiotics instead of appendectomies.