Appendicitis Antibiotics could often prevent surgery

Appendicitis: Antibiotics are often enough
Appendicitis initially leads to severe abdominal pain, but if left untreated it can have serious consequences. In most cases, then an operation is on. However, as researchers found out, medicines can also be an alternative to the scalpel. Thus, a large proportion of patients can be cured with antibiotics.

Patients are usually operated on
An appendicitis (appendicitis) is usually accompanied by severe pain in the lower abdomen. In addition, non-specific symptoms such as loss of appetite, nausea or fever often occur. Patients are then operated on quickly in most cases, but this routine may not be necessary, as scientists found out. Accordingly, medications could be a sensible alternative, because with uncomplicated appendicitis, the majority of adult patients can be cured without surgical intervention. In many cases, the administration of antibiotics is sufficient.

Often antibiotic therapy would be sufficient for inflammation of the cecum. (Image: nerthuz / fotolia.com)

Inflammation of the appendix must be treated
This was the finding of Finnish researchers Paulina Salminen of the Turku University Hospital, as reported in the Journal of the American Medical Association ("Jama"). For their study, the researchers studied 530 adults who had come to the hospital with acute complaints and confirmed suspected appendicitis in computed tomography. The term "appendicitis" is medically actually incorrect, because rather the appendage of the cecum - the appendix - inflamed. Already a stuck cherry stone can lead to an inflammation. Failure to treat this may result in a breakthrough of the cecum and dangerous abdominal infections.

In about three quarters of the patients no surgery needed
The study participants were randomly divided into two groups. Some were operated, the others treated with drugs. In the patients from the OP group, the worm appendage was successfully removed in all but one. According to the data, the non-operated symptoms had resolved themselves before surgery. Patients receiving oral antibiotics, first intravenously for three days and then for another seven days, benefited predominantly from this therapy. Thus, in 73 percent of patients, the inflammation subsided during drug treatment. They were able to leave the clinic without surgery, and within the following year, the inflammation did not return to them. However, for the remaining 27 percent, the antibiotic did not show the desired effect and had to be operated on despite the treatment. According to the "Süddeutsche Zeitung", Salminen said: "This clearly shows that patients can weigh and decide between surgery and drug therapy."

Results apply to adults
The researchers emphasized that their results initially apply to adults, and that data for children are not yet substantiated. However, appendicitis is particularly common in children, adolescents and young adults. In complicated appendicitis, surgery is almost always required. When surgical intervention becomes necessary, there are essentially two surgical procedures. On the one hand, a so-called alternating cut can be used, in which the abdomen of the patient is opened above the cecum, so that the inflamed tissue can be removed. And on the other hand, there is the possibility to perform a laparoscopy, in which the instruments are guided through very small cuts in the abdomen. The latter method is considered gentler.

Rethink previous medical routine
In an accompanying commentary ("http://jama.jamanetwork.com/article.aspx?articleid=2320296"), Edward Livingston and Corrine Vons call for reconsidering the medical routine of always operating on appendicitis. "Surgical intervention has helped many patients well for more than 100 years. However, with the development of better diagnostic techniques such as computed tomography and effective broadband antibiotics, appendectomy may be unnecessary in many cases, "said the physicians. "To try antibiotics first and then to operate those whose condition has not improved by this seems to be a sensible course of action." As the editorial states, further, larger examinations are needed to finalize the benefits and risks of the two treatments to clarify. Even though some German doctors today already treat mild inflammation with antibiotics and bed rest, a drug treatment can have side effects and also carries the risk that resistant pathogens will form. An operation, on the other hand, usually proceeds without complications, but remains a major surgical procedure. (Ad)