The Washington Post

Antibiotics for appendicitis

We’ve heard so much lately about the need to reduce our use of antibiotics (to prevent dangerous bacteria from developing resistance to the drugs we use to kill them), it’s surprising to encounter research that advocates administering antibiotics over a different form of treatment.

But that’s just what a study published last Thursday in the online journal does, suggesting that many cases of appendicitis can be treated with antibiotics instead of surgery.

The study notes that appendicectomy (which is the same as “appendectomy”) has been the standard of care for appendicitis since 1889. But the authors’ review of recent research shows that in cases of “uncomplicated” appendicitis — in which there’s no sign of perforation of the organ or peritonitis (inflammation of the abdominal wall) — treatment with antibiotics combined with watchful waiting may be a better idea.

This research looked at results from four randomized controlled trials that together involved 900 adults with uncomplicated appendicitis, just over half of them treated with antibiotics and just under half treated with surgery. At the one-year mark, 63 percent of those treated with antibiotics were deemed to have been successfully treated; they didn’t end up requiring appendicectomy. And that group had about a third fewer complications (such as infections or peritonitis) than the group that underwent surgery.

Still, an editorial accompanying the study points out that appendicitis is pretty likely to strike again within the year after it’s first diagnosed, with a recurrence rate of 20 percent. That argues in favor of continuing the standard practice of performing surgery sooner rather than later instead of just administering antibiotics and waiting for the other shoe to drop.

Have you had appendicitis? How would you feel if your doctor suggested treating it with antibiotics instead of surgery?


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