December 2, 2022

Antibiotics may be first-line treatment for uncomplicated cases of appendicitis: study | Health

Researchers at Duke University School of Medicine have found evidence that antibiotics successfully treat cases of appendicitis.

The research has been published in the ‘JAMA Journal’.

Findings led by Theodore Pappas, MD, a professor in the Department of Surgery at Duke University School of Medicine, cited the consensus of evidence that antibiotics successfully treat up to 70% of appendicitis cases. Surgery, usually performed laparoscopically, remained the definitive option for otherwise healthy patients with a severely inflamed appendix or other factors that increased the risk of rupture.

“Acute appendicitis is the most common abdominal surgical emergency worldwide, affecting approximately one in 1,000 adults,” Pappas said.

“Until recently the only treatment option was surgery, so having a non-surgical approach for many of these cases has a significant impact for patients and the healthcare system,” Pappas added.

ALSO READ: Antibiotics, not surgery, could treat appendicitis in children

Pappas said the criteria for determining the best treatment approach are nuanced, but not overly difficult. Cases of appendicitis – marked by abdominal pain that has often migrated to the lower right side, nausea and vomiting, and mild fever – are confirmed by ultrasound and/or CT scan.

If the scans described no complications, most of these patients could be given antibiotics instead of having an appendectomy. Antibiotics could also be a first-line treatment for patients who have severe symptoms, but also who are older or have medical conditions that add risks to surgeries.

“We think 60 to 70 percent of patients will be good candidates for antibiotic consideration,” Pappas said.

“A lot of people note that patient preferences may factor into the decision, so providing the literature and educating the public is important,” Pappas added.

Pappas added that antibiotics are not always a complete cure. In about 40% of cases, patients who recovered from an attack of appendicitis after receiving antibiotics had another episode and eventually had to have their appendix surgically removed.

“It’s important to consider each case and its unique context when considering patient preferences,” Pappas said.

“If someone shows up with appendicitis and is attending their brother’s wedding the next day, antibiotics may be a good option. If they have appendicitis and are planning to travel to the countryside of Alaska next year, he might consider an appendectomy, given that the condition could recur,” Pappas explained.

In addition to Pappas, the study authors were Dimitrios Moris, a Duke surgical resident, and Erik K. Paulson, chairman of Duke’s Department of Radiology.

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