Antibiotics can be first-line therapy for uncomplicated appendicitis
cases
A review of studies shows that antibiotic therapy is effective in up to
70% of cases that do not have added risks

Date:
December 14, 2021
Source:
Duke University Medical Center
Summary:
With numerous recent studies demonstrating that antibiotics work
as well as surgery for most uncomplicated appendicitis cases,
the non-surgical approach can now be considered a routine option,
according to a review article.



FULL STORY ==========================================================================
With numerous recent studies demonstrating that antibiotics work as well
as surgery for most uncomplicated appendicitis cases, the non-surgical
approach can now be considered a routine option, according to a review
article in JAMA.


==========================================================================
The finding -- appearing Dec. 14 and led by Theodore Pappas, M.D.,
professor in the Department of Surgery at Duke University School
of Medicine -- cites the consensus of evidence that antibiotics
successfully treat up to 70% of appendicitis cases. Surgery, usually done laparoscopically, remains the definitive option for otherwise healthy
patients with a severely inflamed appendix or other factors that increase
the risk of rupture.

"Acute appendicitis is the most common abdominal surgical emergency in the world, striking about one in 1,000 adults," Pappas said. "Until recently,
the only treatment option was surgery, so having a non-surgical approach
for many of these cases has significant impact for both patients and the
health care system." Pappas said the criteria for determining the best treatment approach is nuanced, but not excessively difficult. Appendicitis cases -- marked by abdominal pain that often migrates to the lower right
side, nausea and vomiting, and low-grade fever -- are confirmed with
ultrasound and/or CT scans.

If the scans depict no complications, most of these patients could
receive antibiotics instead of undergoing an appendectomy. Antibiotics
could also be a first-line therapy for patients who have severe symptoms,
but who are older or have medical conditions that add risks to surgeries.

"We think it's going to be 60% to 70% of patients who are good
candidates for consideration of antibiotics," Pappas said. "A lot of
people note that patient preferences can be brought into the decision,
so it is important to provide the literature and educate the public."
Pappas added that antibiotics are not always a complete cure. In about
40% of cases, patients who recover from a bout of appendicitis after
receiving antibiotics have another episode and eventually need their
appendix surgically removed.

"It's important to take into account every case and it's unique context
as we consider patient preferences," Pappas said. "If someone presents
with an appendicitis and they're attending their brother's wedding the
next day, antibiotics may be a good option. If they have appendicitis
and they are planning to head to rural Alaska next year, they might
want to consider an appendectomy, given that the condition could recur."
In addition to Pappas, study authors are Dimitrios Moris, a Duke surgical resident, and Erik K. Paulson, chair of the Department of Radiology
at Duke.

========================================================================== Story Source: Materials provided by Duke_University_Medical_Center. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Dimitrios Moris, Erik Karl Paulson, Theodore N. Pappas. Diagnosis
and
Management of Acute Appendicitis in Adults. JAMA, 2021; 326 (22):
2299 DOI: 10.1001/jama.2021.20502 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/12/211214135129.htm

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