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Will Antibiotics Replace Surgery for Appendicitis?

A study from Finland suggests that in uncomplicated cases, doctors could use antibiotics instead of surgery for appendicitis.
Will Antibiotics Replace Surgery for Appendicitis?
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Do you always need to have surgery for appendicitis? For more than a century, the standard treatment for appendicitis has been surgery to remove the organ. This was usually treated as an emergency because of the fear that an inflamed appendix would burst and spread infection throughout the body cavity. Such sepsis can be deadly.

Is Appendicitis Caused by Infection?

Some time ago, doctors began to wonder if appendicitis might result from infection. An analysis in the Archives of Surgery (Jan. 2010) suggested that this common condition may be precipitated by a viral infection. This epidemiological study noted that there have been many appendicitis outbreaks or clusters in the U.S. and other countries. The investigators suspected an infectious disease trigger such as influenza virus, measles or cytomegalovirus. If the viral infection leads to swollen lymph tissue, it could obstruct the opening of the appendix and lead to bacterial infection or inflammation. If this hypothesis holds up, this kind of uncomplicated appendicitis might respond to antibiotic treatment. That could reduce the need for emergency appendectomy.

Alternatives to Surgery for Appendicitis:

In the last several years, scientists have wondered if appendicitis could be treated instead with antibiotics as other infections are. A study that began in Finland in 2009 examined this question (JAMA, Sep. 25, 2018). The scientists have just reported their five-year follow-up results.

Antibiotics Instead of Surgery for Appendicitis:

A total of 530 patients who presented as having uncomplicated appendicitis were randomly assigned to surgery or antibiotics. The initial antibiotic treatment was IV ertapenem for three days, followed by a week of levofloxacin and metronidazole pills.

During the next five years, nearly two in five of those who had been treated with antibiotics had a recurrence that required surgery. Those who had been treated with surgery had a much higher rate of complications, at 24 percent compared to 6 percent. They also took 11 more days of sick leave. None of the patients initially treated with antibiotics experienced a complication due to delaying surgery for appendicitis.

The authors conclude that their research

“supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis.”

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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