Antibiotic treatment: an alternative to appendicectomy/Appendectomy surgeries for acute appendicitis!

Every year millions of people with appendicitis are rushed into emergency surgery---this is about to change!

 Most think that if the appendix is not immediately removed, it will burst — with potentially fatal consequences.

Now some doctors say there may be another option: antibiotics.

Five small studies from Europe, involving a total of 1,000 patients, indicate that antibiotics can cure some patients with appendicitis(Click here for the research article); about 70 percent of those who took the pills did not require surgery (appendicectomy).

Of these patients, even those who later had to go for surgery had no increased complications.

 Many emergency specialist surgeons are optimistic about it:

“These studies seem to indicate that antibiotics can cure appendicitis in many patients; you at least have the chance of avoiding surgery altogether.”

Dr. David Flum and others want to compare the results of antibiotics and surgery.

By suggesting an antibiotic alternative, the researchers are bucking longstanding medical tradition.

Little Background:

Surgical treatment for appendicitis began in the 1880s, when surgery itself was new. Doctors struggled to figure out which patients to operate on, because the procedure was dangerous and they knew some patients would get better without it.

As surgery and anesthesia improved, however, the appendectomy became the treatment of choice.

A little Science:
It made sense; for years, doctors thought the appendix — a tiny worm-shaped tube that hangs off the right side of the colon — became inflamed because it was blocked by a small piece of hardened feces. As it turns out, though, the vast majority of people with appendicitis do not have such a blockage.

“No one knows what causes appendicitis,” said Dr. James Barone, a retired chairman of surgery at Stamford Hospital in Connecticut and Lincoln Hospital in the Bronx.

An inflamed appendix is not a ticking time bomb, as people like to believe. While perforation occurs in 15 percent to 25 percent of patients, researchers hypothesize that those who get perforations may have a predisposing immune response or infection with certain kinds of bacteria. In others, appendicitis goes away on its own. Interestingly enough even the time that an appendix is inflamed is not necessarily linked to the risk of perforation. Most people with a ruptured appendix already have it when they show up in the emergency room.

Role of Antibiotics:
Surprisingly enough, this is not even the first time they are being considered as possible alternative to an appendectomy.

When antibiotics became available in the 1940s, doctors in England began giving them to patients with appendicitis and reported excellent results. During the Cold War, when American sailors spent six months or more on nuclear submarines prohibited from surfacing, those who developed appendicitis were given antibiotics.

“Those submariners did great, and no deaths or complications were reported,” Dr. Flum said.

 But that did not put a dint in the perception that surgery was the treatment of choice. 

In 1961 a Russian doctor stationed in Antarctica, Leonid Rogozov, went so far as to cut out his own appendix when it became inflamed.

There is already a debate in the medical field over whether to tell patients about the antibiotic option, and if so, which patients to tell.

Interesting Little Story:

Richard Redelfs, a 40-year-old man (in washington), woke up with abdominal pain a few years ago. An emergency room doctor told him that he needed immediate surgery for appendicitis.

But Mr. Redelfs was uninsured, and he told the surgeon that he had read online that antibiotics might be a viable alternative.

“Once he found out I didn’t have insurance, it was easy to talk him into prescribing me antibiotics,” Mr. Redelfs said.

He felt better almost immediately. But six months later, Mr. Redelfs felt a twinge in his abdomen and returned to the hospital. This time, he had insurance ;)

He was told that he had appendicitis again, he opted for surgery. “I wanted the peace of mind,” he said.

Important related link: http://www.medscape.com/viewarticle/781798_4

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