Surgery better than antibiotics for appendicitis

Antibiotics should not be used to treat appendicitis, research suggests.

Surgery is still the best option (Photograph: SPL)
Surgery is still the best option (Photograph: SPL)

French researchers found antibiotics were not as effective as surgical removal at treating uncomplicated appendicitis. Drug therapy led to more cases of abdomen inflammation, or peritonitis, than surgery.

The team led by Professor Corinne Vons of the Antoine Beclere University Hospital in Paris said the results dispelled previous research findings that antibiotics were a better option.

These studies had claimed antibiotics could cut out risk of postoperative complications and lower risk of treatment.

But in a study of 239 patients with uncomplicated acute appendicitis, researchers found nine of 120 patients on amoxicillin plus clavulanic acid 3g daily developed peritonitis within 30 days of treatment. This compared with just two of 119 patients who had surgery.

Despite diagnosis of uncomplicated appendicitis by CT scan before treatment began, 18 per cent of patients undergoing surgery were found to have complicated appendicitis with peritonitis.

Of patients on antibiotics, one in nine needed an appendectomy within the 30 days and nearly one in three did so within a year after treatment. Most of these patients had acute appendicitis. The authors concluded: 'Our results suggest that emergency appendectomy remains the gold standard.'

In an editorial, Dr Rodney Mason of the Keck School of Medicine in Los Angeles said antibiotic resistance may have caused treatment failure in some cases.

Stephen Robinson recommends

The Lancet

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