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For some patients suffering from appendicitis, antibiotics may do the trick, a large U.S. trial suggests.
More than 70% of patients who received antibiotics avoided surgery for at least 90 days, according to the new report.
"When we compared the outcomes of people treated with antibiotics alone or surgery to remove the appendix, we found that people receiving either treatment felt well at 30 days," said co-principal investigator Dr. David Talan. "In terms of overall health status, antibiotics were no worse than surgery and allowed most people to avoid an operation in the short term."
Talan is a professor of emergency medicine and infectious diseases at the David Geffen School of Medicine at UCLA.
In the trial, more than 1,500 patients in 14 U.S. states randomly received antibiotics first or an appendectomy. The trial is the largest ever clinical randomized look at appendicitis treatment, the study authors said.
According to Bonnie Bizzell, chairwoman of the trial's patient advisory board, "People treated with antibiotics more often returned to the emergency department, but missed less time from work and school. Information like this can be important for individuals as they consider the best treatment option for their unique circumstance."
About three in 10 patients given antibiotics had surgery within 90 days, according to researcher Dr. David Flum, associate chairman of surgery at the University of Washington School of Medicine, in Seattle. "There were advantages and disadvantages to each treatment, and patients will value these differently based on their unique characteristics, concerns and perspectives."
Initial treatment with antibiotics created a higher risk for patients with an appendicolith -- a calcified deposit within the appendix that occurs in roughly one-quarter of patients. It is associated with more complications and a 40% chance of surgery within 90 days, the researchers said.
The findings were published online Oct. 5 in the New England Journal of Medicine.
-- Steven Reinberg
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