So can we now blast away appendicitis with just antibiotics? A recent publication seems to suggest so, though there is still room for debate. Dr. Peter Minneci was the lead author of this study done at Nationwide Children’s Hospital in Columbus, Ohio. In a one-year period they enrolled 77 children and teens diagnosed with uncomplicated appendicitis and allowed families to choose between surgery and antibiotics only. While 30 chose the antibiotic route, 47 underwent surgery. The antibiotic group improved in a day and recovered faster overall – three days’ recuperation versus 17 days for the surgical group. Interestingly, the average hospital stay was longer for the antibiotic group – 38 versus 20 hours. (The average appendectomy patient went home at 20 hours??!!) Three patients in the antibiotic group did end up needing surgery within 30 days but none had a ruptured appendix. The authors agreed this was a small study and they hope to enroll more hospitals and a larger number of patients. They are also conducting another trial looking at patients with more complicated appendicitis.

Previous studies, however, have shown mixed results. In 2011, Dr. Katherine Liu did a meta-analysis of studies published between 1970-2009 that compared surgery to antibiotics-only. She concluded antibiotic therapy incurs significantly fewer complications compared to the morbidity and mortality of surgery. However, antibiotic treatment did carry a risk of failure or recurrence. While Dr. Liu felt that uncomplicated appendicitis could be safely treated with antibiotics, her meta-analysis was hampered by the criteria used to select studies. Only six out of 398 published studies were included. Even among these six studies there was so much variability between treatment groups, different clinical definitions, antibiotic regimens, etc., that the conclusions may not be reliable.

On the other hand, a study appeared in Lancet in 2011 of 243 adult patients with uncomplicated appendicitis who were randomized to amoxicillin-clavulanic acid (3 g/day) for 8-15 days versus appendectomy. They found 30-day post-intervention peritonitis was higher in the antibiotic group (8% versus 2%), 12% required an appendectomy during the first 30 days, and another 29% between one month and one year (a 26% recurrence rate). Another interesting finding is that Lancet uses such terms as “appendicectomy” for appendectomy and “was not non-inferior” for it didn’t work.

So the appendectomy (or appendicectomy) jury is still deliberating on this issue.

Jeff Ribordy, MD