Antibiotics may be a good option for many cases of appendicitis.
Several randomized trials have shown that treating appendicitis with antibiotics rather than surgery may be safe and effective, but the long-term effects of avoiding an appendectomy have been unclear.
Now in a new study, published in JAMA, researchers did a five-year follow-up of 256 patients who had been randomized in a large trial to receive antibiotics instead of surgery for uncomplicated appendicitis — in which the appendix is not ruptured, there is a low white blood count and there is no fecal blockage.
About 60 percent of the patients never needed an appendectomy. Of the 100 who did eventually need surgery, 70 percent had it in the first year, and none of the 100 had any adverse outcomes related to the delay in performing the operation. The decision to perform surgery was left to the discretion of the treating surgeon, which could have resulted in more operations than necessary.
“If I have a CT scan, and I can see that the appendicitis is uncomplicated,” said the lead author, Dr. Paulina Salminen, a surgeon at the University of Turku in Finland, “I would discuss with the patient the possible results of antibiotic treatment alone or surgery. Then we would make a joint, unbiased decision about what would be best.”