Appendicitis Can Often Be Treated With Antibiotics
About 80 percent of patients can try medication first, study says
By Steven Reinberg
HealthDay Reporter
TUESDAY, June 16, 2015 (HealthDay News) -- Although surgical removal of the appendix has long been a standard treatment, a new study found that almost three-quarters of people treated with antibiotics could be spared the invasive procedure known as appendectomy.
"For more than a century, appendectomy has been the
standard treatment," said the study's lead author Dr. Paulina Salminen,
of Turku University Hospital in Finland.
But about 80 percent of patients with an inflamed appendix, commonly called appendicitis,
don't need to have their appendix surgically removed, and those who
ultimately do need the surgery aren't hurt by waiting, according to
Salminen.
She thinks that this and other studies will change
how appendicitis is treated. "Now we know that only a small proportion
of appendicitis patients need an emergency operation," Salminen said.
However, there are two types of appendicitis -- one
that always requires surgery and a milder form that can be treated with
antibiotics, Salminen explained. "The majority of appendicitis is the
milder form, making up almost 80 percent of the cases of appendicitis,"
she said.
The more serious type of appendicitis can cause the
appendix to rupture. Treating this type of appendicitis requires that
the appendix be removed, she said.
A CT scan can accurately detect which type of appendicitis someone has, Salminen added.
The study's findings were published June 16 in the Journal of the American Medical Association.
For the study, Salminen and colleagues randomly
assigned 530 patients with acute appendicitis to appendectomy or a
10-day course of antibiotics.
The researchers found that appendectomies were 99.6
percent successful. Among patients treated with antibiotics and followed
for a year, 73 percent did not need surgery. However, 27 percent of the
patients treated with antibiotics had to have their appendix removed
within a year after treatment.
But there were no major complications associated with delaying surgery, the researchers said.
Dr. Edward Livingston, deputy editor of JAMA
and coauthor of an accompanying editorial, said, "It's kind of lost to
history why people started doing appendectomies, but it has become so
routine that when someone comes in with appendicitis they get whisked
into the operating room."
However, a lot has changed in 130 years, he said. For
example, the ability to diagnose appendicitis has improved. "It's almost
perfect with CT scans," Livingston said.
In
addition, the antibiotics available are very powerful and can kill
anything in the appendix that can cause infection, he said. "These
changes have made us rethink how we approach appendicitis," Livingston
said.
More than 300,000 appendectomies are done each
year in the United States. However, most patients can be treated with
antibiotics alone, he said.
"Appendicitis of this type is not an emergency.
You can always give somebody antibiotics and see how they do, and if the
appendicitis comes back you can take out their appendix and not have
complications related to the delay," Livingston said.
He added that even though an appendectomy is usually well tolerated, there are risks and pain. And, having an operation is expensive.
"I am a surgeon and I hope to get through life
without ever having an operation," he said. "So if I were given the
option of taking antibiotics and not have surgery, I would take
antibiotics in a heartbeat."
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