Study finds most appendicitis can be treated with antibiotics without surgery

Location Chicago - Heather VanDusen decided surgery was needed when her examination revealed that the pain on the right side of her abdomen was due to appendicitis. But doctors offered her another option, antibiotics.

Antibiotics are a good option for most people with appendicitis, a new study from Finland shows. With antibiotic treatment, almost two-thirds of patients had no recurrence after five years.

This is a major breakthrough in how to treat appendicitis. For decades, the treatment of appendicitis was thought to require surgical removal of the appendix, which has traditionally been treated with surgery because the appendix can rupture easily, which can be life-threatening.

However, advances in medical scans (mostly CT scans) have made it easy for doctors to determine if the appendix will rupture, or if the patient can be treated with antibiotics without surgery.

The results showed that nearly two-thirds of patients with appendicitis were not at risk of a ruptured appendix and could be treated with antibiotics.

"This is a viable and safe option," said the study's lead author, Dr. Paulina Salminen, a surgeon at Turku University Hospital in Finland.

Research has also shown that antibiotics are not only for adults but also children with appendicitis.

The findings were published Tuesday in the Journal of the American Medical Association.

"This is a new era in the treatment of appendicitis," says a journal editorial.

Appendicitis surgery is the most common emergency surgery in the world, Salminen said, with about 300,000 surgeries performed each year in the United States alone. She said her findings suggest that many surgeries could be avoided.

Doctors in the U.S. are also starting to offer antibiotics instead of surgery, giving patients appropriate options.

The study involved about 500 Finnish adults who had CT scans to rule out other serious medical conditions, and half were treated with antibiotics.

Of the antibiotic patients, 100 underwent surgery within five years of treatment - most with a suspected recurrence of appendicitis in the first year. The results showed that antibiotic treatment had a success rate of nearly 64 percent.

Complications, including peri-incision infections, abdominal pain and hernias, occurred in about a quarter of surgical patients, compared with only 7% of antibiotic patients. The antibiotic patients had an average of 11 fewer sick days than the surgery group. In the first year, their treatment costs were reduced by about 60%.

Surgical patients in the Finnish study all underwent routine excision, and non-surgical patients received intravenous antibiotics for 3 days in hospital and then 7 days of medication at home.

Dr. Giana Davidson, a surgeon at the University of Washington, was involved in a similar study that could answer which antibiotics are better than "keyhole" surgery.

"But I don't think it solves all problems," Davidson said.

Heather VanDusen was treated at the University of Washington in 2016. She said she chose antibiotic treatment in part to avoid scarring from surgery.