Is it effective to treat appendicitis solely with antibiotics?

Ten years after receiving antibiotic treatment for uncomplicated acute appendicitis, more than half of the patients had not experienced a recurrence or required surgery for this condition, according to a Finnish team from the University of Turku. Since this team's pioneering work, it has become clear that after confirming the uncomplicated nature of the appendicitis with ultrasound or CT scans, a simple one-week course of antibiotics can be sufficient to cure it.

Antibiotics in the face of the risk of recurrence

This approach significantly reduces the costs associated with hospitalization for appendectomy and avoids the need for surgery. the authors point out in the American medical journal JAMA. "However, the study also shows that nearly a third of these patients are at risk of developing appendicitis again within five years. This is why French guidelines still recommend surgery as the first-line treatment for uncomplicated appendicitis." explains Maxime Collard, a surgeon at Saint-Antoine Hospital in Paris.

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Over the decade studied, the recurrence rate observed in patients initially treated with antibiotics was 37.8%. And 44.3% of them ultimately underwent appendectomy during the decade. Despite this risk of recurrence, the overall complication rate was significantly lower in the antibiotic group, and no significant difference in quality of life was reported between the two long-term strategies.

A minimally invasive surgery is currently being evaluated.

The procedure itself has become less invasive in recent years. It is now most often performed using a minimally invasive method, via laparoscopy, with the advantage of leaving only a small scar and causing less post-operative pain. “Furthermore, this procedure is often performed on an outpatient basis. This less invasive approach is currently being evaluated in the country.” because it also reduces hospitalization costs.” explains Maxime Collard.

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Its definitive nature also has the advantage of sparing the patient the uncertainty linked to a possible recurrence. Antibiotic treatment may nevertheless be used in certain cases, for example as a preventative measure if surgery cannot be performed quickly after an appendicitis attack, but "It is ruled out for pregnant women because it presents a proven risk of inducing a miscarriage," the practitioner concluded.