A dose of antibiotics could be all it takes to treat the throbbing, right-sided abdominal pain that indicates appendicitis. At least, that’s the findings of a five-year study from the University of Turku in Finland now published in the Journal of the American Medical Association.
Appendicitis was long considered a medical emergency requiring surgery to remove the organ in case it burst, which can quickly turn the condition from painful to deadly. Now, advanced imaging technologies, particularly CT scanning, make it easier to determine whether an appendix will burst. For those suffering from a less severe form of an inflamed appendix known as “uncomplicated acute appendicitis,” a 10-day dose of antibiotics may be an effective alternative to surgery.
Over the course of five years, researchers monitored more than 500 Finnish adults aged 18 to 60 who showed up in hospitals suffering from the tell-tale right-side pain. During this trial, patients either underwent an appendectomy or were given a course of antibiotics.
Those given antibiotics were treated with a three-day intravenous dose of ertapenem in the hospital followed by a seven-day course of levofloxacin and metronidazole pills at home. Nearly two-thirds of the 257 patients treated with antibiotics did not need to have their appendix removed in the first five years, while another 100 later required surgery within the trial timeframe. They also had 11 fewer sick days than the surgery group with less than half the amount of associated costs in the first year (however, overall costs over the course of the entire study weren’t published).
Of those who went under the knife, almost a quarter had complications or infections near the incision site or experienced abdominal pain or hernias (compared to just 6.5 percent of antibiotic recipients).
Although the results are promising, an editorial published in the same journal argues the “study failed to meet its prespecified noninferiority margin to demonstrate that antibiotic treatment resulted in clinical outcomes that were ‘no worse than’ outcomes with surgery.”
What's more, there are several limitations of the study worth noting. For starters, the decision for surgery was not randomized and was instead left to the discretion of the treating surgeon. These same surgeons also performed incisions rather than less invasive “keyhole” procedures, which were more conventional in Finland during the time but do not reap the same benefits as the latter, including shorter hospital stays, faster returns to normal activity, and fewer wound infections. The authors also note the three-day hospital stay was a conservative decision on their end, and could in fact be shorter with different antibiotic treatments.
Regardless, it offers a promising new treatment option to a common emergency; one in 20 people will experience appendicitis in the US.