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Will You Choose Antibiotics for Appendicitis?

People suffering stomach pain due to acute appendicitis may be able to take antibiotics for appendicitis and avoid surgery.
Will You Choose Antibiotics for Appendicitis?
Young woman in grey clothes is holding hands on belly. Brunette girl is feeling bad and sick. Sudden onset of diarrhea, stomach ache, pancreatitis, appendicitis attack. Bad junk food concept.

Doctors usually define appendicitis as a medical emergency that should be treated with surgery. Over the last several years, though, doctors have wondered whether infection and inflammation in the appendix might be treated with antibiotics instead. Several studies have suggested the possibility of using antibiotics for appendicitis, but they were relatively small and inconclusive.

Can Doctors Use Antibiotics for Appendicitis?

Now, 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.

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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. .
  • The CODA Collaborative, "A randomized trial comparing antibiotics with appendectomy for appendicitis." NEJM, Oct. 5, 2020. DOI: 10.1056/NEJMoa2014320
  • Mallinen J et al, "Appendicolith appendicitis is clinically complicated acute appendicitis-is it histopathologically different from uncomplicated acute appendicitis." International Journal of Colorectal Disease, Aug. 2019. DOI: 10.1007/s00384-019-03332-z
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