Can Appendicitis Be Treated with Antibiotics Instead of Surgery?
Nearly 200 children in the U.S. are hospitalized for appendicitis every day. That's 700,000 kids a year, whose only treatment option is surgery. But now, there may be an alternative: In a new study, antibiotics alone were shown to be a safe, effective treatment for the condition.
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Researchers at Nationwide Children's Hospital found that three out of four children with early/mild, uncomplicated appendicitis were successfully treated with non-operative measures, and remained so even after one year. Huge news! Especially when you consider that, compared to urgent appendectomy, the use of antibiotics was associated with less recovery time, lower health costs, and no difference in the rate of complications at one year.
"Surgery has long been the 'gold standard' of care for treating appendicitis because by removing the appendix we eliminate the chance that the appendicitis will ever come back," said Katherine J. Deans, M.D., who led the study, published today in JAMA Surgery. "However...we noticed that patients with appendicitis who were placed on antibiotics overnight until their surgery the following morning felt better the next day. So [we] asked ourselves: Do they really need to have surgery?"
For the first study of its kind in the U.S., the researchers enrolled 102 patients ages 7 to 17 who were diagnosed with uncomplicated acute appendicitis between October 2012 and October 2013. Thirty-seven families chose antibiotics alone and 65 opted for surgery. The children in the non-operative group were admitted to Nationwide Children's Hospital and received IV antibiotics for at least 24 hours, followed by oral antibiotics after discharge for a total of 10 days. Among those patients, 95 percent showed improvement within 24 hours and were discharged without undergoing surgery.
One year later, three out of four of them did not have appendicitis again and had not undergone surgery. "Families who chose to treat their child's appendicitis with antibiotics, even those who ended up with an appendectomy because the antibiotics didn't work, have expressed that for them it was worth it to try antibiotics to avoid surgery," said Peter C. Minneci, M.D., who co-headed the study with Dr. Deans. "These patients avoided the risks of surgery and anesthesia, and they quickly went back to their activities."
According to Dr. Deans, the findings are exciting because they expand a family's options. "Most parents are concerned about having surgery, in general," she said. "They're also very concerned about anesthesia. Some parents are very concerned about appendicitis coming back. It's really a matter of aligning your preferences, your values, what you think is most important to you, with the treatment that is best for you and your family."
The researchers added that they intend to follow all the children in this study for as long as possible, to see if those treated with non-operative management continue to thrive.