For hundreds of years, the only treatment for uncomplicated, acute appendicitis was emergency abdominal surgery. For the last four decades, laparoscopic surgery has been the treatment of choice. It leads to less postoperative pain and faster recovery times. Over the last several years, though, doctors have wondered whether infection and inflammation in the appendix might be treated with antibiotics instead. Several studies suggested the possibility of using antibiotics for appendicitis, but they were relatively small and inconclusive.
Clinical Trials of Antibiotics for Appendicitis:
Recent clinical trials suggest that doctors could treat uncomplicated appendicitis with antibiotics. A review of these studies suggests that about 70 percent of people with appendicitis respond well to broad-spectrum antibiotics (JAMA, Dec. 14, 2021). People with an enlarged appendix or a calcified deposit (appendicolith) may well need surgery.
Can Doctors Use Antibiotics for Appendicitis?
Previously, a large, randomized clinical trial published in The New England Journal of Medicine compared the outcomes of antibiotics with appendectomy (NEJM, Oct. 5, 2020). The trial included 1552 adults with appendicitis in 25 different medical centers in the US. Researchers randomly assigned these patients to undergo surgery or take a 10-day course of antibiotics. They followed up on the outcomes for three months.
What Did the Study Find?
Ninety-six percent of those assigned to appendectomy had a laparoscopic procedure, which usually permits faster recovery. Not everyone who took antibiotics avoided surgery completely. Within three months, 29 percent of those taking antibiotics required surgery. Nonetheless, 71 percent of the patients receiving antibiotics did not need follow-up surgery for at least three months. People who took antibiotics were more likely to experience a complication than those who went through surgery. However, most of the people experiencing post-antibiotic problems had an “appendicolith,” a calcified deposit within the appendix. When doctors find an appendicolith, they often expect the the treatment of appendicitis to be clinically complicated (International Journal of Colorectal Disease, Aug. 2019).
What Is the Take-Away?
Patients who would prefer to stay out of the hospital during the COVID-19 pandemic may welcome the option of taking antibiotics for appendicitis. They may wish to ask whether the CT scan used for the diagnosis reveals an appendicolith.
