New research shows that antibiotics are effective in treating appendicitis. Researchers found that antibiotics may be able to eliminate the need for surgery in certain cases. Although antibiotics are used to treat appendicitis for some cases over the years, experts say that many doctors still prefer surgery to avoid the complications associated with appendix infections.
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What should you do if you get an attack of appendicitis?
You’re not alone if your first thought was an appendectomy. This has been the standard treatment for many years.
It’s not the only option.
Research published in the New England Journal of Medicine, (NEJM) shows that antibiotics can delay or eliminate the need for appendectomy.
This is not a new treatment. Doctors and patients have more options thanks to the preliminary results of the largest clinical trial on the subject.
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What the research says
Comparison of the Outcomes of Antibiotic Drugs and Appendectomy (CODA), involved 1,552 patients with appendicitis in 25 hospitals across the country.
Participants in the nonblinded, no-inferiority trial were randomly assigned to either have an appendectomy or a 10-day course antibiotics.
Before switching to oral medication, antibiotics must be administered intravenously for at most 24 hours.
A 30-day health status was the primary outcome. Secondary outcomes included appendectomy in those who were in the antibiotics group, and complications for those who were there for more than 90 days.
30% of those who received antibiotic treatment had an appendectomy within the first 90 days. Appendectomy and complications were more likely in people who had an appendicolith. This is a calcified appendix.
The antibiotics group was more frequent in returning patients to the emergency department. The average hospital stay was the same for both groups. The time that people who were treated with antibiotics lost from school or work was less.
- Overall, antibiotic treatment was not found to be inferior to appendectomy.
- Over the next two years, additional results from the CODA trial are expected.
Experts’ opinion
Dr. Ken Perry, an emergency physician, is the assistant medical director at the Trident Emergency Department at Trident Medical Center in Charleston. Perry explained to Healthline that appendicitis was a diagnosis he must make every day.
“Appendectomy was a classic, very routine surgery. There was very little second-guessing over the years. Perry said that studies like the one in the NEJM would allow doctors to better guide patients and help them get the best treatment for their condition. He said, “There are many other diagnoses, like diverticulitis that have changed how we think about appendicitis.”
Small pouches called diverticula form along the digestive tract and can become infected. “Even though the appendix does not form in the same manner as the other organs/structures, they can be infected with similar bacteria in similar ways. Perry said that doctors are familiar with antibiotics for diverticulitis and there is precedent to a similar treatment plan.
Dr. John S. Kennedy works as a general surgeon at DeKalb Surgical Associates. He is also on the Emory Hospital staff in Atlanta. He has been in practice for 33 years and has treated hundreds of patients with appendicitis with antibiotics, as well as others with surgery.
Kennedy pointed out that half the 8,168 patients with appendicitis were not included for different reasons. Kennedy also noted that children were not included in the research.
Kennedy explained to Healthline that diagnosis was based on the CT scan results. There may have been cases where patients didn’t need antibiotics (a CT can be false-positive).
“Follow up was only 90 days. He stated that the percentage of patients who avoided surgery was definitely lower than 70%.
Appendicitis refers to inflammation or infection of the appendix
The pain may begin around the navel and move down to the lower right abdomen. Other symptoms include abdominal tenderness, nausea and vomiting. Appendicitis symptoms should be immediately reported to a doctor.
Appendicitis, if left untreated can cause serious complications. Appendicitis can cause a rupture of the appendix and release bacteria and pus into your abdominal cavity. This can be life-threatening. Perry suggests that people consider the potential risks associated with each treatment plan.
Appendix rupture is possible if antibiotics are not effective in treating the infection. Surgery comes with its risks. He said that this study allowed for better communication with patients about the risks and benefits of each treatment plan.” Kennedy suggests that people should also consider how sick they are.
He said, “If I was the patient and I wasn’t too tender and I didn’t have fever, vomiting, or high white counts, I think that I would skip the surgery.”
If you have complicated appendicitis, it is likely that you will need surgery. Kennedy continued, “If you have the option to take antibiotics, would you be okay with the 30% or greater possibility of having to have an operation in the future?”
What doctors should consider
Kennedy recommends appendectomy for these cases, taking into consideration the failure rate of antibiotics in cases with an appendicolith.
He also noted that surgeons should consider:
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- Other conditions that can cause pain in the right lower quadrant
- People who are on antibiotics and then need an appendectomy or have to change their schedules can be flexible.
- If you are treating with antibiotics, how compliant your patient is with the required follow-up
- Antibiotics can help certain people avoid surgery but it is not for everyone.
Some surgeons don’t believe that there is a 30% failure rate for antibiotics and won’t even consider it. Kennedy said that some patients fear that the surgeon they just met might not offer the best treatment, even if they do not get surgery.
Perry stated that the general practice for the moment is to keep the appendix.
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Perry stated, “Even though this study is convincing that antibiotics can be a viable treatment plan for appendicitis,”
