Appendicitis, or the inflammation of the appendix at the end of the large intestine, was traditionally (since 1889) treated immediately in the operating room because of the fear that the appendix would burst. Recently, beginning the treatment with antibiotics has become the growing trend. This has been the case more so in Europe than in the United States, where doctors generally still schedule surgery for the next day or two.
The antibiotic treatment, however, only follows for appendicitis that is determined to be 'uncomplicated,' after evaluation by CT scan. On the other hand, complications, such as perforations, require speedy surgery.
The traditional method has lately been challenged by experts and some recent studies. This latest study, published in the British Medical Journal, compared 470 patients on antibiotics (taken intravenously and orally) with 430 patients given surgery.
63% of the antibiotic group (with uncomplicated appendicitis) experienced success through the first year after treatment began. The antibiotic group had a 39% lower risk of complications compared with the surgical group. One-fifth of the antibiotic group returned to the hospital with related symptoms -- 19% of whom suffered complicated appendicitis. The length of hospital stay was not different between the two groups.
The study's attached editorial voiced several reservations. One disadvantage of antibiotics is that it may lead to a worsening condition in the future and a higher complication rate. The study also does not do a cost comparison between antibiotics and surgery. In the end, the editorial suggested more research.
What does this have to do with failure to diagnose appendicitis cases?
What comes to my mind is that if patient is being treated with antibiotics, and their appendix ruptures and they need emergency surgery, can you make the argument that had they gone in earlier and performed a laparoscopic appendectomy, the patient would not have suffered rupture, infection or possible sepsis?
Some may argue that the administration of antibiotics, which may not work, simply prolong the inevitable. One could argue that the patient may have needed surgery anyway, and the earlier care and treatment to definitively treat the appendicitis may be the standard of care.
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