October 2, 2022

Your good health: Antibiotics or first-line treatment for appendicitis

Recently, there has been a trend not to refer all people with appendicitis for immediate surgery

Dear Dr. Roach: My daughter was diagnosed with fecalith after a day of pain and nausea. The expert opinion on his report was that an appendectomy was not necessary at this time. If a flare and pain do not recur, would an elective appendectomy be a wise choice given this first instance of symptoms? If the pain and flare-ups become chronic, I suspect an appendectomy would be the best choice.


The vermiform appendix (meaning “worm-like”) (from Latin meaning “to cling”) is a vestigial organ, a remnant of an internal structure that has disappeared with evolution. It is found at the near end of the large intestine, where the small intestine connects. Inflammation of the appendix – appendicitis – is one of the most common reasons for emergency surgery. Often the inflammation begins in the appendix due to an obstruction, which can be caused by a fecalith, which is a small, hard lump of stool the right size to block the end of the appendix.

Recently, there has been a trend of not sending everyone with appendicitis for immediate surgery. Ninety percent of people treated with antibiotics can avoid surgery; however, of those who had a fecalith, about 70% recovered without surgery within 90 days. The remaining 30% required surgery before 90 days, and half required surgery within four years. Another study compared antibiotics to simple observation, and there was no significant benefit for antibiotics.

Some experts are concerned that the risk of complicated appendicitis (especially a ruptured appendix) is higher in people with fecalith, and that the CT scan used to make the diagnosis cannot always make the diagnosis accurately. . For this reason, it remains the expert opinion of the surgeon as to which should be treated with immediate surgery and which can be safely managed with antibiotics or observation.

In a young, healthy person, most of the risk is in the first 90 days, so if they haven’t had any problems in the first three months, elective surgery would generally not be recommended. The only reason to treat most people nonsurgically is to help them avoid surgery.

Dear Dr. Roach: Does turmeric work to treat arthritis?


Many small studies have shown benefits in people with knee osteoarthritis for reducing pain. In a well-conducted trial comparing the active ingredient turmeric (curcumin) to a placebo, both groups had significant pain reduction, but the turmeric extract group had better pain reduction. There was no improvement in physical functioning, such as walking speed or the ability to climb stairs. There were fewer adverse events in the turmeric extract group than in the placebo group.

There is moderate evidence that turmeric extracts improve pain in people with knee osteoarthritis. I would emphasize that exercise remains an important therapy for both reducing pain and improving function. Unfortunately, there is no medical treatment known to reverse or even slow the progressive damage of osteoarthritis.

Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can email questions to [email protected]