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ACS: Too soon for shift to antibiotics first for appendicitis

Despite changes in European practice for the treatment of acute appendicitis, researchers from the American College of Surgeons said that is it too soon for United States to adopt an antibiotics-first treatment in lieu of appendectomy.

“Despite the generally low rate of complications after appendectomy, some U.S. physicians and the public are questioning whether we should change to nonoperative treatment of appendicitis, as many surgeons in Europe already have done,” Anne P. Ehlers, MD, research fellow, department of surgery, University of Washington, said in a press release.

Ehlers and colleagues conducted a systematic review of six European studies, published between 1995 and 2015 to compare outcomes between antibiotics and appendectomy as first treatment among patients with uncomplicated appendicitis (n = 1,724).

In five of the analyzed studies, appendectomy was required in 24% to 35% of patients who had received antibiotics first, according to a press release.

Ehlers noted that most of the studies had a 1-year follow-up, which may not be long enough to detect whether appendicitis recurs in patients who had antibiotics first treatment. Since the analyzed reviews were from Europe, the differences in health care systems and surgical approaches make it difficult to assess whether the health outcomes would apply to U.S. patients, Ehlers said in the release.

The researchers suggested that antibiotics-first treatment only be offered to patients if they are informed of all the unknown elements associated with that treatment, and should only be done as part of a clinical trial or part of a registry.

“What we found in our review, is that antibiotics-first treatment of appendicitis is probably safe for adults and successful in three out of four patients. However, there are many unanswered questions about outcomes of antibiotics-first treatment that patients have told us are important to them. These include their quality of life, long-term residual symptoms, time to return to work and school, and other financial considerations,” Ehlers said in the release.

Disclosures: The researchers report no relevant financial disclosures.