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Antibiotics often effective in place of appendectomy

Saturday April 7, 2012
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Giving antibiotics to patients with acute uncomplicated appendicitis is a safe and viable alternative to surgery, according to an analysis.

Appendectomy has been the mainstay of treatment for acute appendicitis since 1889, and the general assumption is that the risk of complications, such as perforation or infection, is high without surgery, the study’s authors said. Recent studies have reported fewer problems with antibiotic therapy than surgery in patients with uncomplicated appendicitis, but results have been inconclusive.

A team of researchers at the Nottingham Digestive Diseases Center’s NIHR Biomedical Research Unit in the United Kingdom set out to compare the safety and efficacy of antibiotic therapy as an initial treatment for uncomplicated acute appendicitis. They analyzed the results of four randomized controlled trials involving 900 adult patients diagnosed with the condition. A total of 470 patients received antibiotics, and 430 underwent surgery.

Antibiotic therapy was associated with a 63% success rate after a year and a 31% relative reduction in complications, such as wound infection and incidence of perforated appendicitis or peritonitis, compared with surgery. Of 68 patients treated with antibiotics who were readmitted with recurrence of symptoms, four had a normal appendix condition and 13 had complicated appendicitis. Three patients were treated successfully with another course of antibiotics.

There were no significant differences in either length of hospital stay or risk of developing complicated appendicitis between the two groups of patients.

The role of antibiotics in acute uncomplicated appendicitis "has been overlooked based mainly on tradition rather than evidence," the authors wrote. They suggest a careful 'wait, watch and treat’ policy may be adopted in patients considered to have uncomplicated appendicitis or in whom the diagnosis is uncertain.

However, they said, for those with clear signs of perforation or peritonitis, early appendectomy remains "the gold standard."

Antibiotic therapy "is a safe initial therapy for patients with uncomplicated acute appendicitis," the authors wrote, and "merits consideration as a primary treatment option."

To read the study, visit http://bit.ly/HkFq5s.

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