Antibiotics Or Surgery For Appendicitis: Which Could Be A Better Treatment Option For You?

Antibiotics could be the first-line treatment for most people with appendicitis. Some appendicitis patients may get better without surgery.

Appendicitis is an inflammation of the appendix, a finger-shaped pouch attached to the large intestine on the lower right side of your abdomen. It is one of the most common causes of acute abdominal pain. While the exact cause of appendicitis is not known in many cases, it is generally believed that it occurs when part of the appendix becomes obstructed or blocked. If left untreated, an inflamed appendix can burst, causing bacteria to spill into your abdominal cavity, which can trigger a serious, sometimes-fatal infection called peritonitis. Depending on the condition, treatment options for appendicitis include antibiotics, pain relievers, IV fluids, liquid diet and surgery to drain an abscess or remove your appendix. Appendectomy is a common emergency surgery for appendicitis to remove the infected appendix. But growing evidence suggests that antibiotic therapy could be an alternative to surgery or delay appendectomy.

A new study also supported antibiotic therapy as a first-line treatment for most appendicitis patients. The results of the Comparing Outcomes of antibiotic Drugs and Appendectomy (CODA) trial were published recently in the New England Journal of Medicine.

Both antibiotics and appendectomy are safe

The CODA study included 1,552 patients with appendicitis who were randomized to receive antibiotics or to undergo an appendectomy.

Among the antibiotic group, nearly 7 in 10 patients avoided an appendectomy in the first three months after taking antibiotics for the condition. In four years, just under 50% had the surgery, according to Dr. David Flum, co-principal investigator and professor and associate chair of surgery at the University of Washington (UW) School of Medicine.

"Other outcomes favored either antibiotics or surgery. Putting it all together, antibiotics look to be the right treatment for many, but probably not all, patients with appendicitis," Science Daily quoted him as saying.

Although there are advantages and disadvantages to each treatment, both treatments are safe, and the outcomes may differ based on the patients' unique symptoms, concerns and circumstances, Flum added.

These patients have a higher chance of appendectomy

In the CODA study, the researchers found that those with an appendicolith, a calcified deposit found in about 25% of cases of acute appendicitis, were more likely to experience complications and have a higher chance of appendectomy in the first 30 days. However, after 90 days, they found no greater chance of appendectomy in patients with an appendicolith.

These results underscored the importunate of discussing the pros and cons of both surgery and antibiotics in deciding on the treatment for patients with appendicitis that that may better suit their individual circumstances, stated Dr. Giana Davidson, a UW associate professor of surgery and director of the CODA trial's clinical coordinating center.

So, if you have appendicitis, discuss with your surgeon about the potential benefits and harms of each treatment approach. As the study results suggest sometimes appendicitis may get better with antibiotics, and you may not need surgery.

Others, beware of the appendicitis symptoms such as pain in the lower right side of your abdomen, loss of appetite, indigestion, nausea, constipation, abdominal swelling, and low-grade fever.