Anthony Charles, M.D., M.P.H., professor of surgery at the University of Vermont Larner College of Medicine, wrote an editorial accompanying a follow-up study on the use of antibiotics for uncomplicated acute appendicitis, rates of recurrence, and subsequent appendectomy at 10 years indicating that the strategy is a safe and feasible alternative to surgery, according to MedPage Today. The study found that in the decade after participating in the Appendicitis Acuta (APPAC) trial, 37.8 percent of patients who received antibiotics instead of appendectomy had a true, histopathologically confirmed recurrence of appendicitis, while the cumulative appendectomy rate was 44.3 percent.
Dr. Charles noted that this study “underscores the role of shared decision-making in the management of uncomplicated appendicitis.”
“The issue is no longer about a right vs wrong management pathway but between a medically acceptable and a surgically definitive strategy with very different risk-benefit profiles,” he wrote, adding that antibiotic therapy is “highly likely to be cost effective from a societal perspective.”
Despite that potential economic advantage, he cautioned, “the final management decision must still be shared, because the cost to an individual patient in terms of anxiety, time in the hospital, and potential future illness may outweigh the societal economic benefit.” A patient who decides to take antibiotics in this situation must have long-term access to follow-up care, Charles said, a potential challenge for those without insurance or in underserved populations.