Do antibiotics work as well as surgery for appendicitis?
If you have generalized abdominal pain around the belly button that worsens over a few hours or a day and moves to the lower right quadrant of your abdomen, then you are experiencing the textbook description of appendicitis.
“Appendicitis, which is an infection and inflammation of the appendix is the most common general surgical emergency in the world,” said Sean Rumrill, MD, a Falmouth Hospital surgeon with Cape Cod Surgeons.
Other symptoms can include nausea, vomiting, diarrhea, fever, and chills.
Historically, appendicitis has been treated with an appendectomy done by laparoscopic surgery. However, some studies over the past few years have touted antibiotics as a non-surgical option for the treatment of appendicitis.
A December 2021 review article in the Journal of American Medical Association (JAMA) published by Duke Health, stated recent studies had demonstrated that antibiotics worked as well as surgery for most uncomplicated cases of appendicitis. The consensus was that antibiotics treated up to 70 percent of appendicitis cases.
Significant Antibiotic Failure Rate
“There have been many studies that have tried to determine the benefit of treating appendicitis with antibiotics rather than surgery,” said Dr. Rumrill. “But the data shows that there is a significant failure rate of treating with antibiotics only. With antibiotic treatment only, the patient would have a 10 percent risk of recurrence of appendicitis within 30 days. In a year it goes up to 30 percent risk, and within five years there is a 40 percent risk that it will come back.”
He said an appendectomy is “a more definitive and reliable treatment for the disease.”
“I have not used antibiotics instead of surgery and I typically don’t recommend it because the diagnosis of early, non-complicated appendicitis is usually by CT scan, which can’t see everything,” Dr. Rumrill said.
Dr. Rumrill said he does have a conversation with all his patients that antibiotic treatment in place of surgery is an option, but he has never had a patient who chose antibiotic treatment, instead choosing a definitive treatment.
Complications of Appendicitis
Appendicitis continues to be a common occurrence in general surgical practice.
“As one of four surgeons in our practice, we each do an average of two appendectomies a month,” said Dr. Rumrill. “So probably 10 patients per month come through Falmouth Hospital with acute appendicitis which is about one patient every three days.”
While appendicitis can be seen in all age groups, it is most common in younger school-age children and adolescents up to 20 years, he said. The incidence begins to decline in the 20s and 30s age group and can increase a little bit in 50 and 60-year-olds. ‘It is typically a young person’s disease, although we recently had a patient in her 70s,” he said.
While most patients who have appendicitis go home the day after surgery, there are a couple of situations when they may need to stay in the hospital longer.
Dr. Rumrill noted two possible complications:
- A ruptured appendix may require a longer hospital stay to be treated for an infection. If the appendix has ruptured, an infection can spread throughout the abdomen. A surgeon will remove it and insert a drain because pus and bacteria have leaked into another area of the abdomen. The drain will prevent the formation of a pocket of infection (abscess). IV antibiotics are part of the treatment.
- A ruptured appendix that has an abscess formed around it is another complication. If the risk of surgery to remove the appendix is too high, then a radiologist will insert a drain through the skin called a percutaneous drain using ultrasound or CT guidance. This will drain the infection over time and treatment will include IV antibiotics. In about eight weeks, the appendix can be removed.
