Our Summary

This research paper is about a study comparing the use of antibiotics versus surgery (appendectomy) for treating adults with confirmed acute appendicitis. The researchers analyzed data from several other studies (randomised controlled trials or RCTs) that compared these two treatment options.

They found that antibiotics are a safe alternative to surgery for most patients. In fact, close to two-thirds of patients who were treated with antibiotics did not need to have their appendix removed during the first year of treatment. However, the results were different for patients who had an appendicolith (a calcified deposit within the appendix that can cause appendicitis). In these patients, using antibiotics as the initial treatment increased the risk of complications compared to having an appendectomy. Also, about half of these patients ended up needing surgery within the first year.

The researchers concluded that these findings should be taken into account when deciding on the best treatment option for individual patients. In other words, while antibiotics can be a good choice for many people, they might not be the best option for patients with an appendicolith.

FAQs

  1. Are antibiotics a safe alternative to appendectomy for treating acute appendicitis in adults?
  2. Is the risk of complications higher for patients with an appendicolith who are treated with antibiotics instead of surgery?
  3. How effective is the antibiotic treatment for appendicitis in preventing the need for surgery within the first year?

Doctor’s Tip

A doctor might advise a patient considering an appendectomy to discuss their individual case with their healthcare provider to determine the best treatment option based on their specific circumstances, such as the presence of an appendicolith. It is important for patients to fully understand the risks and benefits of both antibiotics and surgery before making a decision. Additionally, patients should follow their doctor’s recommendations for post-operative care to ensure a smooth recovery.

Suitable For

Overall, patients with confirmed acute appendicitis are typically recommended for appendectomy, which is the surgical removal of the appendix. However, for some patients, particularly those without an appendicolith, antibiotics may be a safe and effective alternative to surgery. It is important for healthcare providers to consider individual patient factors, such as the presence of an appendicolith, when determining the best course of treatment for acute appendicitis.

Timeline

Before Appendectomy:

  • Patient experiences symptoms of appendicitis such as abdominal pain, nausea, vomiting, and fever.
  • Patient undergoes physical examination, blood tests, and imaging tests (such as ultrasound or CT scan) to confirm the diagnosis of appendicitis.
  • Once appendicitis is confirmed, patient is given antibiotics to reduce infection and inflammation in the appendix.

After Appendectomy:

  • Patient undergoes surgery to remove the inflamed appendix (appendectomy).
  • Recovery time after surgery typically ranges from a few days to a few weeks, depending on the individual patient and any complications that may arise.
  • Patient may experience pain and discomfort after surgery, which can be managed with pain medication.
  • Patient is advised to rest, avoid strenuous activities, and follow a specific diet to aid in recovery.
  • Follow-up appointments with the surgeon may be necessary to monitor healing and ensure there are no complications.
  • In the long term, patient can resume normal activities and should not experience recurrent appendicitis since the appendix has been removed.

What to Ask Your Doctor

  1. What are the risks and benefits of undergoing an appendectomy compared to using antibiotics for treating acute appendicitis?
  2. How likely is it that antibiotics will successfully treat my appendicitis without the need for surgery?
  3. What factors should be considered when deciding between antibiotics and surgery for treating my appendicitis?
  4. How long will it take for antibiotics to start working and alleviate my symptoms?
  5. What are the potential complications or side effects of using antibiotics instead of surgery for treating appendicitis?
  6. How will my recovery time differ if I choose antibiotics over surgery for my appendicitis treatment?
  7. Are there any specific criteria or conditions that would make me more or less suitable for antibiotic treatment for appendicitis?
  8. What follow-up care or monitoring will be necessary if I choose antibiotics over surgery for my appendicitis treatment?
  9. How will the presence of an appendicolith impact the effectiveness of antibiotics for treating my appendicitis?
  10. Are there any other treatment options or considerations I should be aware of when deciding between antibiotics and surgery for my appendicitis?

Reference

Authors: Scheijmans JCG, Haijanen J, Flum DR, Bom WJ, Davidson GH, Vons C, Hill AD, Ansaloni L, Talan DA, van Dijk ST, Monsell SE, Hurme S, Sippola S, Barry C, O’Grady S, Ceresoli M, Gorter RR, Hannink G, Dijkgraaf MG, Salminen P, Boermeester MA. Journal: Lancet Gastroenterol Hepatol. 2025 Mar;10(3):222-233. doi: 10.1016/S2468-1253(24)00349-2. Epub 2025 Jan 16. PMID: 39827891