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Doctors May Soon Prescribe Antibiotics Rather Than Surgery For Treating Appendicitis

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For many years, doctors treat appendicitis by surgically removing the appendix to prevent further complications with thousands of patients undergoing appendectomy to avoid the potentially deadly symptoms of the infection.

Appendicitis is the inflammation of the appendix, a worm-shaped pouch connected to the large intestine. If the condition remains untreated, the inflamed appendix will eventually perforate or burst and spill infectious materials.

The condition is currently considered as a medical emergency that require surgical removal of the appendix. Findings of a new study published in the journal JAMA on Tuesday, however, could make surgery an option and no longer the standard treatment for appendicitis patients.

For the study, Paulina Salminen, from Turku University Hospital in Finland, and colleagues involved more than 500 appendicitis patients and randomly treated them with either surgery or antibiotics. They found that 186 of the 256 patients who were given antibiotics no longer required appendectomy during the one-year follow-up period.

The findings suggest that antibiotics can cure inflammation without the patient going under the knife providing an option for those who do not want to undergo surgery to treat their condition.

Salminen noted that the results of their study only applied for those with uncomplicated appendicitis as her team excluded the 20 percent of the volunteer patients who have complicated cases from participating in the trial. These include those who have perforated appendices and those who have the rock-like blockage of the appendix known as appendicolith.

"Most patients randomized to antibiotic treatment for uncomplicated appendicitis did not require appendectomy during the 1-year follow-up period, and those who required appendectomy did not experience significant complications," the researchers wrote.

Edward Livingston a surgeon and editor at JAMA said that the time has arrived to consider abandoning routine surgical treatment for those who have uncomplicated appendicitis.

"The operation served patients well for more than 100 years," Livingston wrote. "With development of more precise diagnostic capabilities like CT and effective broad-spectrum antibiotics, appendectomy may be unnecessary for uncomplicated appendicitis, which now occurs in the majority of acute appendicitis cases."

Some experts, however, noted that antibiotics were not enough as 70 of the patients, or a quarter of those who received antibiotic, underwent surgical intervention within a year and this failure rate, according to Philip S. Barie, a surgeon at Weill Cornell Medical College, is unacceptable.

The patients who underwent surgical operations after receiving antibiotic drugs, however, did not experience complications compared with their counterparts who underwent appendectomy right away.

Photo: Mario | Flickr

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