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Surgery May Beat Antibiotics for Appendicitis, Study Finds
Date:5/6/2011

By Steven Reinberg
HealthDay Reporter

THURSDAY, May 5 (HealthDay News) -- Although some researchers believe antibiotics can often cure appendicitis, surgery remains the more effective treatment, French investigators suggest.

Uncomplicated appendicitis may be treated with antibiotics alone, but complicated appendicitis, where the appendix is perforated, requires surgery, and it is difficult to discern between the two, the researchers say.

"With the current technology, it is not possible to distinguish between uncomplicated and complicated appendicitis," said lead researcher Dr. Corinne Vons, of the Assistance Publique-Hopitaux de Paris and Universite Paris XI.

"Therefore, we cannot treat uncomplicated appendicitis with antibiotics," she said. In the future, with improved imaging, "it will be possible," she said.

The report was published in the May 7 edition of The Lancet.

For the study, Vons' team followed 239 patients diagnosed with uncomplicated acute appendicitis, based on a CT scan, who were randomly assigned to treatment with antibiotics or an appendectomy. The researchers looked for cases of peritonitis, an inflammation of the wall of the abdominal cavity, in the 30 days following treatment.

They found that those treated with antibiotics -- 3 grams of amoxillin plus clavulanic acid for 8-15 days -- had a significantly higher incidence of peritonitis (8 percent), compared with those who underwent surgery (2 percent).

In addition, 21 of the appendectomy patients (18 percent) were found to have complicated appendicitis with peritonitis, despite the CT scan results.

Moreover, 14 patients treated with antibiotics (12 percent) needed an appendectomy during the month after treatment. Another 30 required an appendectomy between one and 12 months after initial antibiotic treatment. More than a quarter of those patients had suffered a recurrence of acute appendicitis, which mad
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