Antibiotic treatment for appendicitis does not prevent surgery
By the staff editors of HospiMedica International
Posted on 07 Dec. 2021
A new study suggests that although antibiotic therapy may prevent or delay an appendectomy, 50% of patients will eventually require surgery.
Researchers at the University of Washington (UW; Seattle, USA), Beth Israel Deaconess Medical Center (Boston, MA, USA) and other institutions conducted a study of 1,552 patients with appendicitis in (414 of them with appendicolitis) who were randomized to receive antibiotics (776; of which 47% were not hospitalized for standard treatment) or to undergo appendectomy (776; of which 96% underwent laparoscopic intervention). The primary endpoint was the state of health at 30 days.
Image: Antibiotics for appendicitis can only delay surgery (Photo courtesy Getty Images)
The results showed that although 20% of patients still required an appendectomy within 30 days of starting a 10-day antibiotic treatment, the percentage of patients in the antibiotic group who had an appendectomy by the follow-up was 40% after one year, 46% after two years, and was higher in patients with appendicolitis. The risks tended to peak after two years, but the number of patients who were studied for that long was smaller. The study was published on October 25, 2021 in The New England Journal of Medicine.
“For the treatment of appendicitis, antibiotics were not inferior to appendectomy, based on the results of a standard measure of health status,” concluded lead author David Flum, MD, of the UW School of Medicine, and colleagues. “In the antibiotic group, nearly three in ten participants had an appendectomy at 90 days. Participants with appendicolitis were at greater risk for appendectomy and complications than those without appendicolitis.
An appendicolith is a calcified deposit of feces in the appendix. They are present in a large number of children with acute appendicitis, and may be an accidental finding on an abdominal x-ray or CT scan. The presence of appendicolitis is an independent prognostic risk factor for treatment failure in the non-operative treatment of acute uncomplicated appendicitis, and has also been shown to be associated with appendicular perforation.