Mild Appendicitis Complication Rates Similar for Surgery, Antibiotics

Antibiotics can be used to treat mild appendicitis, but the condition returns in some patients who receive the drugs, researchers report.

Surgical removal of the appendix (appendectomy) has long been the standard treatment for appendicitis, which is when the appendix becomes inflamed and infected.

Millions of appendectomies are performed worldwide each year, including more than 300,000 in the United States, according to the new analysis.

The international team of researchers reviewed five studies that included a total of 1,116 patients with mild appendicitis. They found that rates of complications were similar for those who received antibiotics (5 percent) and those who had an appendectomy (8 percent).

Of the patients who initially received antibiotics, 8 percent had an appendectomy within a month and 23 percent had a recurrence of appendicitis within 12 months.

According to the 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," study co-author Dr. Ville Sallinen, a gastrointestinal surgeon at Helsinki University Hospital in Finland, said in a university news release.

"Used as the primary treatment, antibiotics reduced the number of surgeries by 92 percent within the first month of diagnosis," study co-author Kari Tikkinen, an adjunct professor, said in the news release.

"However, this choice of treatment meant that appendicitis recurred in 23 out of 100 patients within one year. Moreover, no long-term follow-up exists for now," Tikkinen added.

The researchers also wondered if increased use of antibiotics to treat mild appendicitis would contribute to the growing problem of antibiotic resistance.
But with no clear-cut evidence for or against antibiotic treatment, they said the decision might come down to personal preference.

"In medicine and surgery, treatment choices are increasingly based on shared decision-making, where patients and care providers make decisions together. I expect that this will also increasing apply to treatment of mild appendicitis," said Tikkinen.
The study findings were published recently in the British Journal of Surgery.

More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about appendicitis.
Posted: March 2016