Newspaper article International New York Times

Drugs Can Treat Appendicitis, Study Finds ; Antibiotics Preferable to Surgery in Most Cases, Finnish Researchers Says

Newspaper article International New York Times

Drugs Can Treat Appendicitis, Study Finds ; Antibiotics Preferable to Surgery in Most Cases, Finnish Researchers Says

Article excerpt

A Finnish study found that three out of four patients who took antibiotics to treat appendicitis, instead of having surgery, recovered easily.


For more than 100 years, the standard treatment for appendicitis has been surgery. Now a large Finnish study provides the best evidence to date that most patients can be treated with antibiotics alone.

The study, published on Tuesday in JAMA, the Journal of the American Medical Association, involved 530 patients ages 18 to 60 who agreed to have their treatment -- antibiotics or surgery -- decided at random.

Three out of four who took antibiotics recovered easily, the researchers found: The pain vanished, and they went on with their lives. And none who had surgery after taking antibiotics were worse off for having waited.

"The time has come to consider abandoning routine appendectomy for patients with uncomplicated appendicitis," Dr. Edward H. Livingston, a surgeon and editor at the journal, who was not involved with the study, wrote in an editorial accompanying the report.

The study comes amid growing questions about the routine use of surgery to treat appendicitis, which strikes about 300,000 Americans a year, afflicting one out of 10 adults.

The new results apply only to uncomplicated appendicitis, said Dr. Paulina Salminen, a surgeon at Turku University Hospital in Finland and lead author of the new study. She and her colleagues excluded the 20 percent of patients with complicated cases -- people with perforated appendices or abdominal abscesses, and those with a little, rock-like blockage of the appendix called an appendicolith.

To distinguish the complicated from the uncomplicated cases, the Finnish doctors used CT scans, which, Dr. Livingston said, are "almost perfect for diagnosis."

But Dr. Philip S. Barie, a surgeon at Weill Cornell Medical College in New York, noted that antibiotics were not sufficient for more than a quarter of the patients in the new study and said the failure rate was unacceptable.

Patients should have the simple and safe operation to remove their appendix, he said, taking care of the problem quickly and permanently.

Dr. Livingston disagreed. When he saw the results, he said in an interview, his first thought was, "Wow. I've been waiting for this."

Dr. Livingston began wondering about the role of surgery 10 years ago when he operated on a young man with appendicitis who experienced a rocky recovery. The case prompted him to review the medical literature.

He found that much of the original research was done by a surgeon, Dr. Reginald H. Fitz, who in 1886 investigated why people die from pelvic infections.

Dr. Fitz looked at autopsy reports and found many patients whose appendices had been inflamed. That led him to conclude that the appendix may become injured, then infected, then gangrenous; finally, he theorized, a lethal infection spreads through the pelvis. …

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