With many recent studies showing that antibiotics work as well as surgery for most cases of uncomplicated appendicitis, the non-surgical approach can now be considered a routine option, according to a review article in JAMA.
The finding – published Dec. 14 and led by Theodore Pappas, MD, professor in the Department of Surgery at Duke University School of Medicine – cites the consensus of evidence that antibiotics successfully treat up to 70% of cases of appendicitis. Surgery, usually performed laparoscopically, remains the definitive option for otherwise healthy patients with a severely inflamed appendix or other factors that increase the risk of rupture.
âAcute appendicitis is the most common abdominal surgical emergency in the world, affecting approximately one in 1,000 adults,â Pappas said. “Until recently, the only treatment option was surgery, so having a non-surgical approach to many of these cases has a significant impact on both patients and the healthcare system.”
Pappas said the criteria for determining the best approach to treatment are nuanced, but not overly difficult. Cases of appendicitis – marked by abdominal pain that often migrate to the lower right side, nausea and vomiting, and mild fever – are confirmed by ultrasound and / or CT scan.
If the scans show 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 are older or have health issues that add risk to surgeries.
âWe believe 60% to 70% of patients will be good candidates to consider antibiotics,â Pappas said. “Many people note that patient preferences can be factored into the decision, so providing the literature and educating the public is important.”
Pappas added that antibiotics aren’t always a complete cure. In about 40% of cases, patients who recover from an attack of appendicitis after receiving antibiotics have another episode and eventually require surgical removal of their appendix.
âIt is important to take each case and its unique context into account when considering patient preferences,â said Pappas. âIf someone has appendicitis and is attending their brother’s wedding the next day, antibiotics may be a good option. ‘Alaska next year, he might consider an appendectomy, since the condition could recur.
In addition to Pappas, the study’s authors are Dimitrios Moris, a surgical resident at Duke, and Erik K. Paulson, chairman of Duke’s radiology department.
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