If you have acute appendicitis, your risk of inflammation of the wall of the abdominal cavity within thirty days of surgery is 2%, compared to 8% if you have no surgery and receive antibiotics, researchers from Assistance Publique-Hôpitaux de Paris and Université Paris XI, Paris, France, revealed in the journal The Lancet. There is also a significant risk of appendicitis recurrence if you just have antibiotic treatment.

The authors explain that experts have often suggested that antibiotics can effectively treat acute appendicitis. Professor Corinne Vons and team set out to compare the effectiveness of the following two treatments for uncomplicated acute appendicitis:

  • Amoxicillin plus clavulanic acid
  • Emergency appendectomy – surgically removing the appendix

243 patients with uncomplicated acute appendicitis were enrolled at six university hospitals in France. They were aged between 18 and 68 years. Their condition had been assessed by CT scan.

Half of them were randomly selected to receive amoxicillin plus clavulanic acid, 3 grams per day for 8 to 15 days, while the other half underwent emergency appendicectomy.

Their aim (primary endpoint) was to measure the risk of post-intervention peritonitis – inflammation of the wall of the abdominal cavity – within a month of starting treatment.

Below are some highlights of their findings:

  • Postintervention peritonitis occurred within thirty days in 8% of the antibiotics-only group
  • Postintervention peritonitis occurred within thirty days in 2% of the emergency appendectomy group
  • Among those who had an appendectomy, 18% (21) of the 119 were found to have complicated appendicitis and peritonitis during surgery, despite CT-scan assessment
  • 12% of those in the antibiotic group ended up having an appendectomy within thirty days of the initiation of treatment
  • A significant number of those in the antibiotic group had a recurrence of acute appendicitis with a year
  • 30 of the 120 in the antibiotic group had to undergo an appendectomy within a year

The authors concluded:

“Our results suggest that emergency appendicectomy remains the gold standard for treatment of acute uncomplicated appendicitis.”

In a Comment in the same journal, Dr Rodney J Mason, University of Southern California, Keck School of Medicine, Los Angeles, CA , USA, wonders whether antibiotic resistance might have undermined the efficacy of treatment in the antibiotic group. He adds that perhaps using a different antibiotic could produce better results.

Dr. Mason concluded:

“I congratulate Vons and colleagues for tackling this important, controversial, and relevant topic. Hopefully their conclusion…will not overshadow major advances that have been made in the past 15 years towards the conservative treatment of appendicitis. The fact that two-thirds of patients can be spared an operation deserves more attention.”

“Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial”
Prof Corinne Vons MD, Caroline Barry PhD, Sophie Maitre MD, Karine Pautrat MD, Mahaut Leconte MD, Bruno Costaglioli MD, Mehdi Karoui MD, Prof Arnaud Alves MD, Prof Bertrand Dousset MD, Prof Patrice Valleur MD, Prof Bruno Falissard MD, Prof Dominique Franco MD
The Lancet, Volume 377, Issue 9777, Pages 1573 – 1579, 7 May 2011

Written by Christian Nordqvist