Antibiotics May Be Better Than Appendectomies in Some Cases
If effective, antibiotics have some clear advantages over surgery for the management of acute ]]>appendicitis]]> . Antibiotic treatment is pain-free and eliminates the risks of surgery and post-surgery complications; it also shortens in-patient time and reduces medical costs.
The April 27, 2006 issue of World Journal of Surgery reports on the efforts of researchers to compare the effectiveness of antibiotic treatment versus ]]>appendectomy]]> . Over a three-year period, they performed the first randomized, multicenter trial on a large series of patients comparing antibiotics to appendectomies for the treatment of appendicitis.
About the Study
The Swedish Society of Medicine, the Wallenius Corporation, and Aventis Pharma funded the study, which was conducted at six Swedish hospitals. Males aged 18-50 with confirmed appendicitis were randomized either to surgery (open or ]]>laparoscopic]]> ) or to a course of antibiotics (intravenously for two days, followed by oral treatment for 10 days). Participants were monitored at the end of 1 week, 6 weeks, and 1 year. (If symptoms of appendicitis did not improve after one day of antibiotics, an appendectomy was performed).
Of 252 participants, 124 were assigned to the surgery group and 128 to the antibiotic group. In the antibiotic group, 86% improved without surgery. While all patients in the surgery group improved, the complication rate was 14% and time off work was greater overall than in the antibiotic group. The rate of recurrence of appendicitis among the patients treated with antibiotics was 14% during the one-year follow-up.
A possible limitation of this study is that it included only men, however, researchers reasonably expect the same results would apply to women.
How Does This Affect You?
This study suggests that some patients with suspected acute appendicitis do not necessarily need an emergency appendectomy. A 24-hour course of antibiotics can be safely administered, and, if symptoms are relieved, surgery may be avoided.
Anyone with the symptoms of appendicitis, such as abdominal pain, should seek emergency treatment immediately. Regardless of whether an appendectomy is necessary, antibiotics must be administered initially in a hospital setting. And medical follow-up is essential.
The National Institute of Diabetes and Digestive and Kidney Diseases
The Society of American Gastrointestinal and Endoscopic Surgeons
Styrud J, Erikkson S, Nilsson I, Ahlberg G, Haapaniemi S, Neovius G, et al. Appendectomy versus antibiotic treatment in acute appendicitis: a prospective multicenter randomized controlled trial. World J Surg .2006 April;30:1033-1037.
Last reviewed August 2007 by ]]>Richard Glickman-Simon, MD]]>
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