Antibiotics can treat acute appendicitis

 Treatment with antibiotics is a safe and effective alternative to surgery for acute appendicitis, according to a new study published in the BMJ.

A meta-analysis of four clinical trials showed that antibiotic therapy achieved a 63% success rate while reducing complications by 31% relative to surgery.

The study concluded that antibiotics should be considered as a first-line therapy for uncomplicated appendicitis.

In cases where appendicitis has led to peritonitis or perforation, surgery remains essential, the researchers said.

Removal of the inflamed appendix has been the standard treatment for acute appendicitis since 1889 – but the study argued that this is based “mainly on tradition rather than evidence”.

The study, by researchers at the Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, compared the safety and efficacy of antibiotic therapy with surgery as a first-line treatment for uncomplicated acute appendicitis.

It analysed the results of four randomised controlled trials covering 900 adult patients diagnosed with uncomplicated acute appendicitis, of whom 470 received antibiotics and 430 underwent surgery.

Treatment with antibiotics was associated with a 63% success rate at one year, and offered a 31% reduction in risk of complications compared to surgery.

There were no significant differences in length of hospital stay or risk of developing complicated appendicitis between the two patient groups.

The researchers suggested that a ‘wait, watch and treat’ policy could be adopted in patients who appear to have uncomplicated appendicitis, since the benefits of using only antibiotic therapy outweigh the risks.

Antibiotic therapy is “a safe initial therapy for patients with uncomplicated acute appendicitis” and “merits consideration as a primary treatment option for early uncomplicated appendicitis,” they concluded.

However, early surgery would remain the standard treatment for patients with clear signs of perforation or peritonitis.