Appendicitis can be treated using antibiotics, does not require surgery always

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Most cases of uncomplicated acute appendicitis can be treated using antibiotics and do not require surgery, according to a large study from Finland that has turned on its head the standard treatment for the very common, painful and potentially life-threatening abdominal infection.Using antibiotics alone treated three in five patients with uncomplicated, with only 39.1% of the patients initially treated with antibiotics alone needing surgery over the next five years, found the five-year observational follow-up of 257 patients ages 18 to 60 years in Finland.
“This long-term follow-up supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis,” the say authors in the study published in JAMA, which is the Journal of American Medical Association.
The appendix is a finger-shaped pouch in the colon located in the lower right abdomen. Once considered a useless, vestigial organ that was expendable, the appendix has lately been identified as a reservoir for beneficial “good” gut bacteria, which helps the digestive system recover after bouts of diarrhoeal and other gastrointestinal illnesses.
For more than a century, surgery has been the standard treatment for appendicitis, which is an inflammation of appendix because of acute infection and that causes symptoms of sudden, severe pain in the lower abdomen, nausea, vomiting and abdominal bloating. Uncomplicated appendicitis is infection without complications such as perforation, abscess, or suspicion of a tumour.
Antibiotic treatment led to fewer complications and faster recoveries, with the antibiotic group taking an average of 11 days of sick leave to recover, compared to 22 days taken by those who underwent surgery. Antibiotics also lowered complication rate to 6.5%, compared a rate of 24% post surgery, mostly as a result of infections.
Though the study did not compare costs, patients who do not undergo an operation spend less on treatment, including treating surgical complications.
On average, the surgery patients stayed in the hospital for three days, while those treated using antibiotics were given three days of intravenous drugs in hospital, followed by one week of oral antibiotics prescription after discharge. The antibiotics used were intravenous Ertapenem for three days followed by seven days of oral Levofloxacin and Metronidazole, all of which are broad-spectrum antibiotics that act against a wide range of disease causing bacteria.
An important finding was that none of the patients in the antibiotics group who eventually needed an operation had complications related to delaying surgery. “Although patients may be concerned about the ultimate need for surgery from the health outcome perspective, non-surgical treatment in uncomplicated appendicitis before proceeding for surgery is a reasonable option,” said an accompanying editorial in JAMA.