For the past 100 years appendectomy has been the primary treatment for appendicitis, but new scientific evidence is challenging the notion that surgery is the best treatment for the disease. Increasingly, the surgical community is questioning whether antibiotics alone (an “antibiotics-first” strategy) is a reasonable alternative to appendectomy.
Success with antibiotics-alone in Navy personnel developing appendicitis at sea (who did not have access to an operating room) supported this strategy. Additionally, five randomized trials involving over 1,000 patients in Europe have shown that an antibiotics-first approach is likely safe.
It is currently unknown if the benefits of avoiding an operation with the antibiotics-first approach are outweighed by the potential burden to the patient. For example, there is a possibility of recurrent appendicitis, more days of antibiotics, lingering symptoms, or uncertainty that may impact quality of life.
While appendectomy remains the standard treatment for appendicitis, CERTAIN believes clinicians should inform all patients about the evidence related to the antibiotics-first strategy. Given the uncertainty about the risks and benefits of the antibiotics-first strategy, it is recommended that all patients treated in this way be followed in registries or trials. To that end, CERTAIN is collaborating with a team from University of California, Los Angeles to build a nationwide registry to capture information about patient outcomes following an antibiotics-first approach for appendicitis.
If you are a clinician who is interested in becoming an advisor or collaborating on future research in this area, please contact us to get involved.
New York Times Antibiotics Are Effective in Appendicitis, Study Says (6/17/15)
New England Journal of Medicine Acute Appendicitis — Appendectomy or the “Antibiotics First” Strategy Subscription Required (5/14/2015)
Forbes.com Appendicitis: Should You Have Antibiotics Alone Or Surgery, Too? (5/14/2015)
Blog Would YOU Randomize? CERTAIN Asked - You Answered (1/9/2015)
If you are a clinician who sometimes treats appendicitis with an antibiotics-first approach, we encourage you to contribute to our growing registry.
If you or someone you care for has been treated for appendicitis with antibiotics, please share your experience by completing a short survey. Click on the link below.
The registry does not contain data through intervention or interaction with the individual patient or identifiable private information. Under Code of Federal Regulations (45 CFR 46), this is not considered human subject research.
The University of Washington Human Subjects Divisions does not require institutional review of this registry. We encourage you to confer with your local institutional review board prior to participating. Learn more.