Appendicitis? Antibiotics May Be All You Need

My appendicitis two years ago fit this description but I was never offered anything but surgery. It was readily done and I left the next day without complications. But I would have liked to try antibiotics or have been offered the choice.

I had mine out laparoscopically nine years ago and have had no end of pain and cramps from adhesions. I wish that I had been offered at least the option of antibiotics first.

25 years ago I went to the emergency room and was initially diagnosed with appendicitis. They started prepping me for surgery when a second doc was brought in who decided against surgery. He did tell me to not stray too far from a major city on my worldwide travels. For years after that I would occasionally get pain down there but stuck it out, using OTC pain relievers. Fast forward 20 years and had the same symptoms but worse pain. This time they yanked it out. I've not had those pains since, which leads me to believe that my body was fighting that infection all those years. I'm happy it's gone. And I'm happy I live in the USA, a first-world country with outstanding medical care.

A 40% (at least) failure rate for observation for a condition that can kill you dead in excruciating agony of peritoneal sepsis is not a very sound foundation for suggesting it's appropriate for most patients. Surgical appendectomy is an extraordinarily safe procedure that has little downtime in most instances. Antibiotic treatment is a prolonged course, often requiring days of hospitalization with a high failure rate. I would be surprised if you ran the numbers on lost productivity and direct costs that it would not be more expensive to manage this non operatively

My husband had his appendicitis treated with antibiotics two years ago. As we are both biologists, we read up on the literature while waiting in the E.R. and saw that Europeans routinely use antibiotics to treat appendicitis, and raised the possibility with the resident. Luckily, he was at a university-affiliated research hospital (Robert Wood Johnson in New Brunswick) where the resident had read the same studies and was willing to give it a try. My husband still had to sign an "Against Medical Advice" waiver, but he was home that evening with a prescription for high-dose antibiotics, and hasn't had any issues since. Plus, with his high-deductible insurance plan, it probably saved us several thousand dollars in medical bills. Still, it was on us to be well-informed, skeptical healthcare consumers.

I received antibiotics at age 21 in 1975 at Georgetown University Hospital for appendicitis. Twenty years later I had same symptoms and appendix was removed at Morristown Memorial Hospital. I probably could have been treated with antibiotics but I was nursing a baby and wanted to be done with issue ASAP. Antibiotics were not offered however. Just knew about the possibility based on previous event. Surgery was at 3 AM. I left the hospital same day at 3 PM. Dr wanted me to stay until next day but I felt fine.

Good story. Here's the other side: risk of surgery. I was sitting on a gurney in Roosevelt Hospital in 2016 when the resident told me the pain in my lower right abdomen was indeed appendicitis. He recommended immediate surgery. It's quick, safe, solves the problem, and I could be out in 24 hours. I said, "How safe? What's the surgical mortality?" He said, "Very safe. Under 1%." I said, "1% doesn't sound so safe to me. Suppose I had a jar of 100 jelly beans. One of them was filled with cyanide. I offer you a jelly bean. Would you take it?" He said, it depends on the benefit. I said, I read about the Swedish studies of antibiotics. That has no mortality at all. The resident said yes, he knew about it. The problem is that it requires IV antibiotics several days, and doesn't always work. Then they got the CT scans. The attending agreed with me that, particularly because my appendix was inflammed, antibiotics would be worth trying. The resident was right. I spent a week in hospital with an IV drip in my forearm. I was discharged, but a week later it recurred. I spent another week in hospital. Finally it was over, and never came back. Then, I looked up the mortality rate. True, textbooks say <0.1%. However, a Swedish study stratified the results by age, and at my age, 73, the mortality rate was 1.6%. Not the kind of jelly bean I would want to eat. Kudos to my surgeon, who knew when *not* to operate. Roosevelt did a good job, if you're scoring.

Always good to take the conservative approach as long as the criteria are evidence based. It's cheaper and safer.