Authors: Carmen Cox
(NOTTINGHAM, England) -- For patients who suffer from acute, uncomplicated appendicitis, physicians have considered surgery as the most reliable treatment since the late 1800s. Now, researchers report that treatment with antibiotics may be a safe alternative to surgery.
Dr. Dileep Lobo, professor of gastrointestinal surgery at the University of Nottingham and Queen's Medical Centre, said beginning antibiotic therapy soon after diagnosis is most important.
"Starting antibiotics when the diagnosis of uncomplicated acute appendicitis is made, with reassessment of the patient, will prevent the need for most appendectomies, reducing patient morbidity," he said.
Researchers led by Dr. Lobo analyzed the results of four randomized trials involving 900 adults with uncomplicated appendicitis. A total of 470 patients received antibiotics, and 430 underwent surgery. They found that 63 percent of those treated with antibiotics no longer needed further treatment after one year. Thirty-one percent saw a reduction in complications compared to those treated with surgery, according to their analysis, published Thursday in the British Medical Journal.
But, Dr. Lobo noted, while correct diagnosis is key, rather than an early appendectomy, "for patients with clear signs of perforation or peritonitis (an inflammation of the abdominal wall), early appendectomy still remains the gold standard."
The researchers added that there were no significant differences in either length of hospital stay or risk of developing complicated appendicitis between the two groups of patients.
On the other hand, an accompanying editorial to the study, written by Dr. Olaf Bakker of the University Medical Center Utrecht in the Netherlands, notes that while antibiotic treatment appears better than surgery, there is a 20-percent chance of recurrence within a year with antibiotic therapy. Dr. Bakker wrote, "It is questionable whether a failure rate of 20 percent within one year is acceptable."
Until further study is completed, appendectomies will likely remain as the standard when treating appendicitis, Bakker said.
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