The Medicine Cabinet-Ask the Harvard Expert
By Howard LeWine, M.D.
Q: A friend recently was diagnosed with appendicitis. She was treated with antibiotics only, no surgery. Doesn’t appendicitis always require an appendectomy?
A: For more than 100 years, surgery has been the recommended treatment for appendicitis. However, recent studies suggest that antibiotics and no surgery might be safe and just as effective for many people. The results of some recent medical studies support this view.
In the United States, almost everyone with belly pain that could be caused by appendicitis gets a CT scan. It’s an extremely accurate test to diagnose the condition. The scan can also show whether it’s a simple or complicated case.
Complicated appendicitis means that the CT scan shows one or more of the following:
1. An abscess (pus pocket in or around the appendix)
2. A perforation (an appendix that burst)
3. A stone or hard ball of stool blocking the opening of the appendix
Anyone with features on a CT scan showing that it may be complicated appendicitis should have surgery. Also, the studies have not included children, elderly people and pregnant women. So, antibiotics for now should be considered primarily for healthy adults.
I had a personal experience with simple appendicitis 18 months ago. My symptoms were typical but not severe. I had pain that started earlier in the day in the middle of my belly. During the next few hours, the pain moved down into the lower right part of my belly.
I did not have fever, nausea or vomiting. These are common symptoms, even in people with simple appendicitis.
My CT scan confirmed the diagnosis of simple early appendicitis. The Emergency Department doctor gave me the option of antibiotic treatment or surgery.
I did believe that a trial of antibiotics would have been a very safe choice. And most likely I could have avoided immediate surgery.
However, I opted for laparoscopic appendectomy. My reason: We don’t have long-term results on how likely it is that simple appendicitis treated with antibiotics will come back someday. I didn’t want to take a chance on having appendicitis again, especially if I was traveling to some remote place in another part of the world.
Others in my situation might not want surgery, even if their surgical risk is extremely low. For them, antibiotics only with close follow-up should be considered a reasonable initial therapy.
(Howard LeWine, M.D., is a practicing internist at Brigham and Women’s Hospital in Boston and Chief Medical Editor of Internet Publishing at Harvard Health Publications, Harvard Medical School.)
(For additional consumer health information, please visit www.health.harvard.edu.)