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Antibiotics for Appendicitis an Option for Some

Antibiotics Instead of Surgery Safe for Some, Experts Say; Others Say More Research Needed
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Antibiotics for Appendicitis: Second Opinion

The idea does make sense, says Bakker, the editorial writer. He also participated in the writing of Dutch national treatment guidelines for acute appendicitis, he tells WebMD in an email interview.

However, he writes, "the use of antibiotics as first-line treatment for appendicitis has major disadvantages." One is the delay in surgery, if the condition progresses. That has been linked with a high complication rate, he says.

While doctors use imaging tests to evaluate the condition, "it's not 100%," Bakker tells WebMD

"The [study] tackles an interesting issue, but also shows that we need more evidence," he says.

The Approach in the U.S.

The concept of antibiotic treatment is catching on much more slowly in the U.S. than overseas, says Paresh C. Shah, MD, director of laparoscopic surgery and a gastrointestinal surgeon at Lenox Hill Hospital in New York. He reviewed the findings for WebMD.

"The concept of treating it with antibiotics has been around in Europe for a long time," he tells WebMD.

Many U.S. doctors do support the idea of initial treatment with antibiotics and delayed surgical intervention if the condition does not look complicated, he says.

In years past, he says, if someone came to the hospital with appendicitis, surgery would be performed as soon as possible, even in the middle of the night.

Now, he says, a typical approach if the doctor believes it is uncomplicated is to start antibiotics but also schedule surgery for the next day or so.

One shortcoming of the analysis, he says, is lack of data on costs.

While surgery would be more costly, Shah notes that the difference may not be that great. The antibiotic group was in the hospital while on IV drugs. The researchers found no overall differences in length of hospital stays between the groups.

The study and editorial are published online in BMJ.

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