The People's Perspective on Medicine

Will Antibiotics Replace Surgery for Appendicitis?

A study from Finland suggests that in uncomplicated cases, doctors could use antibiotics instead of 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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    My concerns about this are twofold. First, I would worry that antibiotic treatment would merely delay the ultimate need for surgery, and that when the infection reappeared it might do so in a more severe and urgent form. Secondly, maybe simple surgery would be preferable to the long term side effects of some very toxic antibiotics.

    I had very few symptoms before my appendix burst; just a slight flu-like feeling, and I was “cleared” by a doctor a few days before I had emergency laparoscopic surgery. The doctor had told me I was fine; maybe a flu bug. The watery matter which came out of my body a couple days later indicated that my appendix had burst.

    I’m always concerned about “more” antibiotic use, as so many antibiotics have been over-prescribed and over-used through the years. Later, they seem to be overpowered by super bugs.

    Very interesting. Here in Australia, this past April, I worked a country fair and ate salami. 6 hours later I had a terrible gut pain that continued for 2 days until I called an ambulance. The ambos suggested it was appendicitis, and I was admitted to hospital, where I was given Caphalexin and Metronidazole and put on an operating list. The next day I felt 100% better and refused the operation. I remained convinced that this was food poisoning, and knew enough medicine to argue (I am a podiatrist) with the doctors, tho’ it did not make me popular. 2 days later I was released with more anti-biotics and have not had a problem since.

    I read up on possible food pathogens (my friends call me Dr Google. LOL) I found Clostidium perfringens, a nasty little bug with a 6 to 12 hour incubation and found in salami. I wonder how many people with food poisoning are misdiagnosed? Also, the ileo-cecal valve, which is where the small intestine empties into the large bowel, is located directly above the appendix. Interestingly, I tried to persuade the doctors to give me an enema, but they would not. This would be first line treatment in Europe. In Europe by naturopaths and Heilpraktiker it is believed that the appendix is a ongoing reservoir of ‘good’ bacteria for the lower bowel. Also, and this enrages me, the gynecologists wanted to take out my ovaries because I was post menopausal. Do they remove men’s gonads just because they are of no further use? Men would put up a big fight.

    When we are given antibiotics, they disturb and destroy our healthy gut biome and also cause yeast infections or thrush. There is a place for antibiotics of course, but I’m not sure that taking that many antibiotics instead of having an appendectomy is always a good idea.

    Recently had a bowel resection after what doctors surmise was a burst appendix. Too destroyed to know for sure but estimate it happened 10 days before they saw me. Why so long? I did not have a fever, nausea or pain until about 36 hours before I saw a doctor with surgery later that day.

    However, about 11 months earlier I did present with the usual symptoms of appendicitis, went to an urgent care facility, was given prespcription for cipro, took it recovered. Now I can ‘t help but wonder if I had appendix issues last year and the bursting was delayed because of the antibiotics.

    Makes no difference at this point but a point to ponder.

    When I was 12 I had appendicitis and the doctors gave me an enema and it went away. I had the same complication when I was 21. The college hospital wanted to operate and take my appendix out but I told them if they gave me an enema I would be alright. They did and I have not had a problem with my appendix since. I believe there are other things that can reduce the inflammation in the appendix as well antibiotics or better than antibiotics. In my case enemas worked.

    As a pathologist, I often saw fibrous obliteration of the appendix at autopsy or colon resection. Mild appendicitis, like diverticulitis. can heal. Antibiotics sometimes help both infections heal.

    Gangrenous appendicitis, where the infection has destroyed most of the appendicitis is fatal unless operated. Perforated diverticulitis or appendicitis leads to a pericolic or periappendiceal abscess. It is theoretically possible to drain internally with antibiotics but it must be a one in a million

    I would be very concerned about being treated with fluroquinolones. I would rather have surgery under regional anesthesia.

    I thought the current surgery for appendicitis did not require cutting, but use laparoscopic surgery which requires less down time. It is terrible to have to go through ER when you have appendicitis pain and then get surgery because the charge is excessively high in the 5 digit figure.

    Something is really wrong with Medical care in the US. Hospitals charge $10.00 for ONE aspirin.

    My comment is that sometimes appendicitis is Not only acute. Both my husband and daughter had stomach aches that would come and go. ) Eventually it did not go away and it was their appendix, and appendectomy was required. Drs. described it as ‘very strange’ case.

    I think this is much more common than people think. I had a slowly progressing case of appendicitis that went on for 2-2 1/2 years before it was diagnosed. I was finally scheduled for surgery which, as it happened came just in time as I was very ill at that point. Later on I talked to several nurses who said they had heard of, or had, first-hand experience with “chronic,” meaning slowly progressing, cases of appendicitis.

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