New Study Looks At Treating Appendicitis With Antibiotics

PITTSBURGH (KDKA) - For years, we've thought the only way to treat appendicitis was to remove the appendix.

Well, what if you could treat it simply with antibiotics?

A new study could turn everything we know about appendicitis on its head.

"I would just go with the non-invasive form first, and if that didn't take care of the situation, then I would definitely go for the surgery," one woman said.

"Surgery is usually the last resort. But, I'm also very skeptical of antibiotics. I avoid them whenever possible," one man said.

"I just don't like people cutting into my body so yeah, antibiotics sounds preferable," another man said.

A recent review of the available research has led to a study showing antibiotics for unruptured appendicitis can be safe.

"It does look like there are some people you can try this in. The key to that, though, is that you're not excluding surgery entirely. What you're saying is we're going to try this for 24-48 hours, and if there's any change at all, worsening at all, that they go to surgery immediately," Dr. Allan Philp, a surgeon at Allegheny General Hospital, said.

"Surgeons are very open to non-surgical approaches," Dr. Michael Morowitz, a surgeon at Children's Hospital, said. "Particularly, in patients that are older, or have other medical conditions."

In fact in Europe, treating with antibiotics first is a common approach. But, not in America.

"In some small European studies, it actually showed benefit to patients. However, I don't think we can extrapolate the data to our country," Dr. Marc Itskowitz, of Allegheny General Hospital Internal Medicine said. "I would be very uncomfortable sending a patient home with antibiotics. I much prefer them to have the definitive treatment, which is surgery."

The appendix is a three-inch long work-shaped, tubular appendage that hangs off the beginning of the large intestine.

It can get inflamed and swollen from blockage or infection.

When that happens, the thought is it has to come out, before it bursts, spewing infection into your belly.

The treatment differences between Europe and the United States may be related to surgical technique. In the U.S., up to 80 percent of the cases are done with small tubes and scopes through small incisions with a small complication rate of less than three percent.

In Europe, larger incisions are the standard, which is why they are looking at other options. Of note, one-in-three patients who had antibiotics first went on to have surgery anyway.

With rapid recovery, a day in the hospital and back to school or work in a week, it's unlikely watchful waiting on antibiotics will catch on in the U.S.

To answer the question more clearly, we will need well-designed trials comparing treatments. Because up to one-in-ten people -- typically between the ages of 10 and 30 -- will have appendicitis, it should be easy to have enough patients to carry out such trials.

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