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To Your Health: NLM update Transcript

Appendicitis: Antibiotic treatment or surgery?: 06/22/2015

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Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D., senior staff, U.S. National Library of Medicine (NLM).

Here is what's new this week in To Your Health, a consumer health oriented podcast from NLM, that helps you use MedlinePlus to follow up on weekly topics.

Patients with uncomplicated appendicitis may recover similarly if they receive antibiotic treatments rather than surgery to remove their appendix, suggests a recent study from Finland and an accompanying editorial in the Journal of the American Medical Association.

In a randomized control trial of 273 and 257 Finnish patients who received surgery and a 10 day antibiotic treatment respectively, the study's 14 authors found one approach to treatment and recovery was not statistically significantly inferior to the other.

All participants in the study received a CT scan that confirmed uncomplicated appendicitis prior to random assignment to the antibiotic or surgical group. The study notes most patients (about 80 percent) experience an uncomplicated or a milder form of appendicitis.

Overall, the study's authors write (and we quote): 'Most patients randomized to antibiotic treatment for uncomplicated appendicitis did not require appendectomy during the one-year follow up period, and those who required appendectomy did not experience significant complications' (end of quote).

In an editorial that accompanied the study, its two authors add the findings do not apply to patients with complicated appendicitis, children, and pregnant women (who were excluded from the Finnish study).

The editorial's authors add the Finnish study is somewhat limited by its statistical design and more research is needed to explore the extent of the statistical differences between surgery and antibiotic treatment.

The editorial's authors note an appendectomy (the name of the surgical procedure) is the commonly accepted treatment for appendicitis around the world. However, the editorial's authors conclude (and we quote): 'The report does provide good evidence that antibiotics may be a reasonable alternative to appendectomy for patients with acute, CT-verified uncomplicated appendicitis' (end of quote).

In turn, the editorial's authors add in the future (and we quote): 'Investigators will need to determine and fully justify how much worse than appendectomy antibiotic treatment of appendicitis must be before the notion of replacing appendectomy with antibiotic treatment is rejected' (end of quote).

Meanwhile, a guide to understanding appendicitis (from the Mayo Foundation for Medical Education and Research) is available in the 'start here' section of MedlinePlus.gov's appendicitis health topic page. The American Academy of Family Physicians provides information about abdominal pain in the 'diagnosis/symptoms' section of MedlinePlus.gov's appendicitis health topic page.

The American College of Radiology explains the safety and accuracy of CT scans for appendicitis also within the 'diagnosis/symptoms' section of MedlinePlus.gov's appendicitis health topic page.

MedlinePlus.gov's appendicitis health topic page additionally provides links to the latest pertinent journal research articles, which are available in the 'journal articles' section. Links to relevant clinical trials that may be occurring in your area are available in the 'clinical trials' section. You can sign up to receive updates about appendicitis as they become available on MedlinePlus.gov.

To find MedlinePlus.gov's appendicitis health topic page type 'appendicitis' in the search box on MedlinePlus.gov's home page, then, click on 'appendicitis (National Library of Medicine).'

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