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Bytram (from IRC) writes:

After century of removing appendixes, docs find antibiotics can be enough:

After more than a century of slicing tiny, inflamed organs from people's guts, doctors have found that surgery may not be necessary after all—a simple course of antibiotics can be just as effective at treating appendicitis as going under the knife.

The revelation comes from a large, randomized trial out of Finland, published Tuesday, September 25, in JAMA.

Despite upending a long-held standard of care, the study's finding is not entirely surprising; it follows several other randomized trials over the years that had carved out evidence that antibiotics alone can treat an acute appendicitis. Those studies, however, left some dangling questions, including if the antibiotics just improved the situation temporarily and if initial drug treatments left patients worse off later if they did need surgery.

The new JAMA study, with its full, five-year follow-up, effectively cauterised those remaining issues. Nearly two-thirds of the patients randomly assigned in the study to get antibiotics for an uncomplicated appendicitis didn't end up needing surgery in the follow-up time, the Finnish authors, based at the University of Turku, report. And those drug-treated patients that did end up getting an appendectomy later were not worse off for the delay in surgery.

"This long-term follow-up supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis," the authors conclude.

The finding suggests that many appendicitis patients could be spared the risks of surgical procedures, such as infections. They may also be able to save money by not needing such an invasive procedure (although the study didn't compare costs), and they could reap the benefits of shorter treatment and recovery times. Researchers will have to collect more data to back up those benefits, though.

JAMA, 2018. DOI: 10.1001/jama.2018.13201

Original Submission