Sunday, May 24, 2015

Cure Appendicitis Now!

It never occurred to me to think appendicitis could possibly be treated with antibiotics. It's just one of those gaps in my thinking.

Medical researchers don't have my problem, though. According to a recent story in the New York Times, clinical trials in France have found that for the one-thousand patients involved,

antibiotics can cure some patients...about 70 percent of those who took the pills did not require surgery.

Patients who wound up having an appendectomy after trying antibiotics first did not face any more complications that those who had surgery immediately.

“These studies seem to indicate that antibiotics can cure appendicitis in many patients,” said Dr. David Talan, a specialist in emergency medicine and infectious diseases at the University of California, Los Angeles. “You at least have the chance of avoiding surgery altogether.”
Three hundred thousand Americans have appendectomies every year -- if that physical and financial cost could be prevented for 210,000 of them, imagine the benefit.

Most adults know someone who has had a burst appendix. It's a bad, bad thing, and I had assumed that it was the outcome of every case of appendicitis that went untreated. I found out from the article, though, that this is not the case: inflamed appendix is not, as most people think, a ticking time bomb. While perforation occurs in 15 percent to 25 percent of patients, researchers hypothesize that those who get perforations may have a predisposing immune response or infection with certain kinds of bacteria. In others, appendicitis goes away on its own.

Nor is the length of time that an appendix is inflamed necessarily linked to the risk of perforation. Most people with a ruptured appendix already have it when they show up in the emergency room.
Fifteen to 25 percent is a large portion of cases -- based on the number needed to treat formula used in assessing the validity of an intervention, it clearly seems worth doing an invasive procedure to protect from that kind of risk.

But then I reread that last sentence from the quote: "Most people with a ruptured appendix already have it when they show up in the emergency room." So maybe the patients who haven't ruptured yet should be given a trial of intravenous antibiotics if the research shows that their outcomes are not worse, even if the appendix eventually rupture.

I also learned from the article that this isn't the first time antibiotics have been looked at as treatment for appendicitis. It started right away, when antibiotics were new in the 1940s, and they have been used off and on in settings that limit access to surgery.

The biggest unknown is whether the appendicitis will reoccur once it's cleared up with antibiotics. Researchers don't know what causes the infection in the first place, and so they can't be sure it won't come back at some point.

From a doctor's point of view, it's a standard, 30-minute operation -- as close to a sure thing as you get in medicine. From the patient's point of view, though, it's costly in terms of time, pain, and money.

If I were the patient, I would try treatment with antibiotics. And it's clearly worth doing more controlled trials with patient follow-up to see what happens over the years.


Gina said...

I finally lost my appendix last August during my abdominal surgery for something else. It was inflamed but had not been giving me any trouble. I'm glad the surgeon took it out. Now I don't have to think about it.

My Aunt Celia died at age 9 in 1920 from what my grandparents believed was a ruptured appendix. My mother was 3 years old at the time. What a difference antibiotics could have made for her! I found it interesting that often the inflamed appendix will resolve on its own and not cause any problems requiring medical attention.

The human body is truly a mysterious and wondrous thing.

Nancy/BLissed-Out Grandma said...

Interesting, and worth keeping in mind!