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Antibiotics 'overlooked' as appendicitis treatment alternative

Antibiotics are a “safe and viable” alternative to surgery for patients with acute uncomplicated appendicitis, a study claims.

It is believed antibiotic therapy may have been “overlooked” on account of the traditional role of surgery as the “mainstay of treatment” for acute appendicitis.

Scientists at the Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit analysed the results of trials involving 900 adult patients diagnosed with uncomplicated acute appendicitis - in which 470 patients received antibiotics and 430 underwent surgery.

The study, published in the British Medical Journal, found over 60% of patients who received antibiotics had their symptoms relived after one year and there was also less change of complications arising from the treatment (31%) when compared to surgery.

Of the 68 patients who were treated with antibiotics and subsequently readmitted with recurrence of symptoms, four had normal appendix and 13 had complicated appendicitis. 

Researchers found no significant differences in either the length of hospital stay or risk of developing complicated appendicitis between the two groups of patients.

The study concludes antibiotics “are a safe initial therapy for patients with uncomplicated acute appendicitis” and they “merit consideration as a primary treatment option for early uncomplicated appendicitis.”

However, it is stressed that for those patients with clear signs of perforation or peritonitis (inflammation of the abdominal wall) an early appendicectomy still remains the 'gold standard.'

The researchers claim the role of antibiotics in acute uncomplicated appendicitis “has been overlooked based mainly on tradition rather than evidence”.

Dr Olaf Bakker from the Department of Surgery at the University Medical Center Utrecht in the Netherlands said until more “convincing” results are published, “appendectomy for uncomplicated appendicitis will probably continue.”

Question: Will you be more confident in prescribing antibiotics for patients with acute uncomplicated appeddicitis following this study?