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New research suggests prescribing antibiotics to treat appendicitis may be just as effective as surgery, without the risks associated with invasive surgical procedures.
Researchers from the University of California, Los Angeles say roughly 70% of patients treated with antibiotics for appendicitis could be able to avoid having a surgical appendectomy.
In a study published last week in the New England Journal of Medicine, researchers outlined the findings of a randomized trial comparing antibiotic therapy with appendectomy among patients with appendicitis at 25 medical centers across 14 states.
Researchers examined data on 1,500 adults, with half of the group was assigned to receive a 10-day course of antibiotics and half undergoing surgical appendectomy.
The findings suggests antibiotics are a viable option to treat appendicitis, and the treatment does not require as much down time for recovery. By contrast, an appendectomy is an invasive surgical procedure, where the entire appendix is removed.
Patients in the antibiotics group missed fewer days of work on average than those in the surgery group. However, in the antibiotics group, 29% of patients eventually had to have a surgical appendectomy within 90 days, and about 40% of those patients suffered a complication of appendicitis known as appendicolith. This is a calcified deposit in the appendix which can lead to other complications.
Appendicitis complications were more common in the antibiotics group, with five complications per 100 patients, compared to three per 100 patients in the surgery group. The increased complication rate may be contributed to the appendicolith complication, which also led to the need for more surgeries. . If the appendix bursts a patient may experience other serious side effects.
Rates of serious adverse events were similar among both groups. However, nine percent of patients in the antibiotics group needed to visit the emergency room or urgent care clinic after diagnosis, compared to only four percent of those in the surgery group.
One month after treatment, patients in both groups rated their general health as about the same.
With antibiotics there is a risk appendicitis may return. Researchers said they need to study the patients and follow-up to determine if the likelihood is high.
Appendicitis is an inflammation of the appendix that typically occurs in the teens or 20s. It is the most common cause of acute abdominal pain requiring surgery. However, some mild cases are treated with antibiotics alone.
About 300,000 people go to the hospital each year for appendicitis-related issues.
“For the treatment of appendicitis, antibiotics were non-inferior to appendectomy on the basis of results of a standard health-status measure,” the researchers wrote. “In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith.”