Taking Charge of Your Health

During the Cold War, if a sailor on an American
nuclear submarine developed appendicitis, the submarine couldn’t just
resurface for an appendectomy. Instead the sailor was usually given
a non-surgical treatment: antibiotics. Once the submarine was able to resurface,
the sailor received surgery if needed. In most cases, the appendicitis
resolved without surgery. Despite this, appendectomy continued to be
the treatment for all cases of appendicitis. But clinical trials now show that for cases
of uncomplicated acute appendicitis diagnosed by abdominal CT scan, antibiotics
is a safe alternative to appendectomy as a first-line approach. However prior studies had focused on
short-term outcomes, 30 days to a year. In the current issue of JAMA we report
results from a five-year follow-up of patients randomized to receive antibiotic
therapy in a trial comparing antibiotics to surgery in patients with
acute, uncomplicated appendicitis. The original trial was designed
to test the non-inferiority of antibiotics compared to surgical management. It randomized 530 patients in
Finland between the ages of 18 and 60 with CT-confirmed uncomplicated
acute appendicitis to appendectomy or antibiotic therapy comprising IV ertapenem
for three days followed by seven days of oral levofloxacin and metronidazole. The one year findings, reported in JAMA in 2015, failed to show that antibiotics were
non-inferior to surgery, although three-fourths of patients treated with antibiotics didn’t
require surgery, and none of the patients who underwent surgery had complications
related to waiting to perform an appendectomy. Now let’s review the 5-year
results, which is what’s new this week. The main outcome of the five-year study
was to establish the recurrence rate of appendicitis treated with antibiotics. The authors report that the cumulative
incidence of recurrent appendicitis in the patients initially treated with
antibiotics was 27% at 1 year, 34% at 2 years, 35% at 3 years, 37% at 4
years, and 39% at 5 years. 70 patients initially treated with antibiotics
underwent appendectomy in the first year of the study and 30 in years 1 to 5. Of these 30 patients, only 2
had complicated appendicitis. The authors conclude that
long-term follow up of patients with CT-diagnosed uncomplicated
appendicitis suggests that initial treatment with antibiotics is a safe
alternative to appendectomy. Not tired of my voice yet? If you’re not and you’re interested in this
topic, make sure to check out the latest episode of the JAMA Clinical Reviews
podcast, which I produce. It reviews the changes in patient management
that have occurred over the past century, which have improved both the diagnosis and
treatments for uncomplicated appendicitis. Plus, we just updated the podcast episode
to include the results of this study. Subscribe at JAMA Network Audio dot com
or anywhere where you get your podcasts.

5 thoughts on “Can Appendicitis Be Treated With Antibiotics Rather Than Surgery?

  1. I’m worried about this, I have the symptoms and have realised I probably have appendicitis, obviously like most people I do not want an operation. I don’t really have time for it either this is so stressful

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