Did You Know? Antibiotics Are Effective in Appendicitis

For more than 100 years, the standard treatment for appendicitis has been surgery. Now a large Finnish study provides the best evidence to date that most patients can be treated with antibiotics alone.

The study, published Tuesday in JAMA, involved 530 patients aged 18 to 60 who agreed to have their treatment — antibiotics or surgery — decided at random.

Three out of four who took antibiotics recovered easily, the researchers found. And none who had surgery after taking antibiotics were worse off for having waited.

“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, who was not involved with the study, wrote in an editorial accompanying the report.

But Dr. Philip S. Barie, a surgeon at Weill Cornell Medical College, noted that antibiotics were not sufficient for more than a quarter of the patients in the new study and said the failure rate was unacceptable.

American submarine sailors during the Cold War were given antibiotics for appendicitis.Antibiotics Resurface as Alternative to Removing AppendixMAY 18, 2015
Patients should have the simple and safe operation to remove their appendix, he said, taking care of the problem quickly and permanently.

The new study comes amid growing questions about the routine use of surgery to treat appendicitis, which strikes about 300,000 Americans a year, afflicting one out of 10 adults at some point in their lives.

The results only apply to uncomplicated appendicitis, stressed Dr. Paulina Salminen, a surgeon at Turku University Hospital in Finland and lead author of the new study. She and her colleagues excluded from their trial the 20 percent of patients with complicated cases — people with perforated appendices or abdominal abscesses, and those with a little, rocklike blockage of the appendix called an appendicolith.

Dr. Livingston began wondering about the role of surgery 10 years ago after he operated on a young man with appendicitis who experienced a rocky recovery.

In reviewing the medical literature, he found that much of the original research was done by a surgeon, Dr. Reginald H. Fitz, who in 1886 investigated why people die from pelvic infections.

Dr. Fitz looked at autopsy reports and found many patients whose appendices had been inflamed. That led him to conclude that the appendix may become injured, then infected, then gangrenous; finally, he theorized, a lethal infection spreads through the pelvis.

The way to prevent this dire chain of events, Dr. Fitz decided, was to remove the appendix. But more recent research has shown that the infected appendix does not become “gangrenous” and — as even Dr. Fitz noticed — some patients simply get better on their own.

In the 1950s, soon after antibiotics were discovered, some doctors reported success using them to treat patients with appendicitis. But, Dr. Livingston wrote in his editorial, “So powerful is the perceived benefit of appendectomy for appendicitis that surgical treatment for appendicitis remains unquestioned, with seemingly little interest in studying the problem.”

Source: New York Times


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