Surgery, rather than antibiotics only, should remain as the mainstay of treatment for acute uncomplicated appendicitis, according to an RCSI University of Medicine and Health Sciences study.
Acute uncomplicated appendicitis is a commonly encountered condition that has traditionally been treated with surgery. In recent years, antibiotic-only treatment has emerged as a potential alternative to surgery, purporting to offer benefits such as an improved quality of life for patients as well as the potential to reduce demands for operating theatres in hospitals. There has been a reluctance to adopt antibiotic-only treatment due to research that has shown wide variability in failure rates and a lack of evidence regarding the impact on quality of life for patients.
In this study, the efficacy and quality of life associated with antibiotic-only treatment of acute uncomplicated appendicitis was analysed versus surgical intervention. The research, published in the Annals of Surgery, was carried out by clinicians from RCSI and Beaumont Hospital, Dublin.
Over 180 patients with radiological evidence of acute, uncomplicated appendicitis were randomised to two groups. One group received antibiotic-only treatment and patients in the other group were treated with surgery. Patients in the surgery group underwent a laparoscopic appendectomy. In those treated with antibiotics only, intravenous antibiotics were administered until there was an improvement in a patient's signs and symptoms and this was followed by five days of oral antibiotics.
Patients were followed up with questionnaires up to 12 months following treatment. The questionnaires measured the patient's pain score, need for additional sick leave, surgical site infections and the development of recurrent appendicitis.
The results from the antibiotic-only group demonstrated that 23 patients (25%) experienced a recurrence of acute appendicitis within one year. In the quality of life questionnaires, it was found that patients in the surgery group experienced a significantly better quality of life score compared with the antibiotic-only group.
The results indicate that surgery will deliver the best outcomes for patients in terms of quality of life and recurrence and therefore should remain as the mainstay of treatment for acute uncomplicated appendicitis.