According to researchers at the University of Gothenburg’s Sahlgrenska Academy in Sweden, antibiotics can replace invasive surgery for the treatment of acute appendicitis involving the removal of the appendix.

Although the standard approach to acute appendicitis is to remove the organ, a clinical study of adult patients with acute appendicitis has revealed that treatment with antibiotics can be just as effective.

“Some patients are so ill that the operation is absolutely necessary, but 80 percent of those who can be treated with antibiotics recover and return to full health,” said Dr Jeanette Hansson, who led the study published in the September issue of the World Journal of Surgery.

The study was conducted at the Sahlgrenska University Hospital in Gothenburg from May 2009 to February 2010.

During the study period, 558 patients were hospitalized due to acute appendicitis. 80 percent of them received antibiotics as first-line therapy and 20 percent had primary surgery as the second-line therapy. The patients were treated with a combination of piperacillin and tazobactam followed by nine days out-hospital ciprofloxacin and metronidazole.

Seventy-seven percent of patients on primary antibiotics recovered, while twenty three percent had subsequent appendectomy due to failed initial antibiotic treatment. The risk of recurrence within 12 months of treatment with antibiotics was around 10-15 percent.

Now Dr Hansson and her colleagues hope to be able to document the risk of recurrence over the long term and also to study whether recurrences can also be treated with antibiotics.

“It’s important to note that our studies show that patients who need surgery because of recurrences, or because the antibiotics haven’t worked, are not at risk of any additional complications relative to those operated on in the first place,” Dr Hansson concluded.

_______

Bibliographic information: Hansson J. et al. 2012. Antibiotics as First-line Therapy for Acute Appendicitis: Evidence for a Change in Clinical Practice. World Journal of Surgery, volume 36, number 9, pages 2028-2036; doi: 10.1007/s00268-012-1641-x