For more than a century, surgery has been the standard treatment for appendicitis. Around the world, millions of appendectomies are performed annually, with more than 300,000 procedures done in the United States alone.

Although past studies have found that other treatment options - such as the use of antibiotics - is just as effective as surgery in treating kids who have appendicitis, the choice of treatment remains unchanged.

Now, a new study conducted by researchers from the University of Helsinki and McMaster University has revealed that using antibiotics to treat appendicitis does not increase the risk of complications at least in the first year of treatment.

In fact, antibiotic use can significantly lower the number of appendectomies by 92 percent within the first month of diagnosis, researchers said.

However, choosing to take antibiotics meant that appendicitis recurred in 23 percent of patients within a year.

Comparing Antibiotic Use And Appendectomy

Researchers had assessed five randomized controlled trials that compared the use of antibiotics to appendectomy in the treatment of appendicitis. The trials involved a total of 1,116 patients.

Nearly the same number of serious complications was found among two groups. For the antibiotics group, the rate was 5 percent of the cases. For the appendectomy group, the rate was 8 percent of the cases.

With the antibiotics group, 8 percent of the patients went through an appendectomy within a month. Appendicitis also recurred in 23 percent of the cases during the 12-month follow-up.

"The studies did not provide a high quality evidence for complications," said Ville Sallinen, a consultant gastrointestinal surgeon at Helsinki University Hospital. "[B]ut according to best evidence available, using antibiotics as the primary treatment for mild appendicitis does not lead to more complications in the first twelve months of follow-up."

A Sensitive Choice

Researchers said the choice between antibiotic use and appendectomy is a value and a preference-based decision.

"In medicine and surgery, treatment choices are increasingly based on shared decision-making, where patients and care providers make decisions together," said Kari Tikkinen, Sallinen's colleague. "I expect that this will also increasing apply to treatment of mild appendicitis."

To initiate the antibiotic treatment, the appendicitis diagnosis must be confirmed by a CT scan.

"A diagnosis must always be made in emergency surgical care," said Sallinen. "The treatment must not be chosen based on suspicion alone."

Implications

Sallinen and Tikkinen pointed out that antibiotics can be used as the first-stage treatment for mild appendicitis. Still, researchers have yet to know how many of those who opted for antibiotic treatment first avoid surgery in the long run.

Additionally, Sallinen mentioned that most diseases are becoming increasingly resistant to antibiotics, saying:

"Would a change in treatment preferences and an increased use of antibiotics further boost this negative trend?"

The findings of the study are featured in the British Journal of Surgery.

Photo: Army Medicine | Flickr