Antibiotics might be first-line therapy for uncomplicated appendicitis cases

The researchers at the Duke University School of Medicine have found evidence that antibiotics successfully treat appendicitis cases.

The research has been published in the ‘JAMA Journal’.

The findings led by Theodore Pappas, M.D., professor in the Department of Surgery at Duke University School of Medicine — cited the consensus of evidence.

That antibiotics successfully treat up to 70 per cent of appendicitis cases. Surgery, usually done laparoscopically, remained the definitive option for otherwise healthy patients with a severely inflamed appendix or other factors that increased the risk of rupture.

“Acute appendicitis is the most common abdominal surgical emergency in the world, striking about one in 1,000 adults,” Pappas said.

“Until recently, the only treatment option was surgery, so having a non-surgical approach for many of these cases has significant impact for both patients and the health care system,” Pappas added.

Pappas said that the criteria for determining the best treatment approach are nuanced, but not excessively difficult. Appendicitis cases — marked by abdominal pain that often migrated to the lower right side, nausea and vomiting, and low-grade fever — are confirmed with ultrasound and/or CT scans.

If the scans depicted no complications, most of these patients could receive antibiotics instead of undergoing an appendectomy. Antibiotics could also be first-line therapy for patients who have severe symptoms, but also who are older or have medical conditions that added risks to surgeries.

“We think it’s going to be 60 per cent to 70 per cent of patients who are good candidates for consideration of antibiotics,” Pappas said.

“A lot of people note that patient preferences can be brought into the decision, so it is important to provide the literature and educate the public,” Pappas added

Pappas added that antibiotics are not always a complete cure. In about 40 per cent of cases, patients who recovered from a bout of appendicitis after receiving antibiotics had another episode and eventually need their appendix surgically removed.

“It’s important to take into account every case and its unique context as we consider patient preferences,” Pappas said.

“If someone presents with appendicitis and they’re attending their brother’s wedding the next day, antibiotics may be a good option. If they have appendicitis and they are planning to head to rural Alaska next year, they might want to consider an appendectomy, given that the condition could recur,” Pappas explained.

In addition to Pappas, study authors were Dimitrios Moris, a Duke surgical resident, and Erik K. Paulson, chair of the Department of Radiology at Duke.