I originally published this in 2015!
I am revisiting this topic following the recent JAMA publication, which examined long-term outcomes over a 10-year period among patients treated with antibiotics. I found it particularly interesting to reflect on my own prior experience with this topic and to place those earlier observations in the context of the new long-term data.
There are a lot confusion/controversy regarding appendicitis treatment :ABx vs surgery:The NOTA Study (Non Operative Treatment for Acute Appendicitis) in Ann surg, 2014 showed that antibiotics for suspected acute appendicitis are safe and effective and may avoid unnecessary appendectomy.
Long-Term Outcomes of Patients with Nonsurgically Managed Uncomplicated Appendicitis in J Am Coll Surg, 2014 with same result.
But there is a JAMA article published today regarding this topic: Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis, There were 273 patients in the surgical group and 257 in the antibiotic group. Patients randomized to antibiotic therapy received IV ertapenem (1 g/d) for 3 days followed by 7 days of oral levofloxacin (500 mg once daily) and metronidazole (500 mg 3 times per day). Patients randomized to the surgical treatment group were assigned to undergo standard open appendectomy.
The result showed that 27 % of patients treated with antibiotics instead of surgery have a recurrence within 1 year. Their conclusion is among patients with CT-proven, uncomplicated appendicitis, antibiotic treatment did not meet the pre-specified criterion for non-inferiority compared with appendectomy.
Probably this will come to our practice in near future (next 5-10 years) we will give options to patient to have abx vs surgery.