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No Need For The Knife? Antibiotics May Suffice In Some Appendicitis Cases

Acute appendicitis generally means a speedy trip to the hospital for surgery. But British researchers say antibiotics might be a safe and effective alternative in uncomplicated cases.

"The general consensus was that the appendix has to be taken out the moment you feel it was inflamed," Dr. Dileep Lobo, professor of gastrointestinal surgery at the University of Nottingham and Queen's Medical Centre, tells Shots.

Appendicitis is an extremely painful and potentially life-threatening condition. The appendix, a fingerlike pouch attached to the large intestine, can sometimes get clogged, causing it to swell with bacteria and burst if it isn't removed in time. Surgery to remove the appendix has been the standard course of treatment since 1889.

It's a relatively simple operation, and one that Lobo says has "been the bread-and-butter operation for most surgical trainees."

But he and his team of researchers at the Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit wanted to know how well antibiotics might work as an initial treatment. They took a hard look at the results of four previous studies on 900 patients in Europe in which 470 people got antibiotics and 430 had surgery for acute uncomplicated appendicitis.

More than 60 percent of those who took antibiotics had no further symptoms after one year. And the risk of complications from antibiotics was more than 30 percent less, compared with appendectomy. The study also notes that the use of antibiotics may reduce deaths from surgery.

However, 20 percent of the antibiotics group had to be readmitted for symptoms: Four had a normal appendix, 13 had complicated appendicitis and required surgery, and three were successfully treated with more antibiotics. The results of the study were published in the British Medical Journal.

"We're not saying antibiotics are going to replace surgery altogether," Lobo says. Surgery should still be the gold standard of care, he says, in cases where patients are exhibiting symptoms of complicated appendicitis, such as high pulse rates and high temperatures, among other things.

"If you treat the 80 percent of patients with uncomplicated appendicitis with antibiotics, you'll probably save about 60 percent of those patients from having an operation," he adds.

Dr. Anupam Kharbanda, assistant professor at the Departments of Pediatrics at the University of Minnesota, tells Shots he's concerned that treating appendicitis solely with antibiotics could lead to patients having recurring symptoms later on.

In the U.S., about 250,000 people each year have their appendix removed, says Kharbanda, who specializes in pediatric appendicitis. About one-third of them are children. He also notes that the risk of death from appendectomy is already very low.

"Most studies would show morbidity from surgery is less than 1 percent," he says.

Still, Kharbanda says, the British findings are worth noting, because any research that says doctors might not need to operate on a good percentage of patients "has to be taken with a significant amount of interest."

While the study won't change the standard of care for appendicitis in the U.S. anytime soon, he says, it will probably prompt more research on the topic.

In the U.K., however, Lobo expects more doctors will soon begin considering antibiotics as a first step toward treating uncomplicated appendicitis. He says if this became part of the protocol, it could save time in the operating room and shorten patients' hospital stays.

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Teresa Tomassoni