Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

Antibiotics May Be Effective for Managing Appendicitis

By David A. Talan, MD | on April 10, 2017 | 2 Comments
Features
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version
Illustration: Adam Talan
Illustration: Adam Talan

“Appendicitis is an obstructed, ischemic ticking time bomb of a finger-like extension of the bowel, which if not urgently removed will burst and lead to death.”

You Might Also Like
  • Latest Research on Nonoperative Treatment of Appendicitis in Pediatric Patients
  • Can Normal C-Reactive Protein Rule Out Acute Appendicitis in Pediatric Patients?
  • Adverse Events Common, Often Avoidable in Hospitalized Patients on Antibiotics
Explore This Issue
ACEP Now: Vol 36 – No 04 – April 2017

For more than 100 years, this understanding guided practice and patient expectations, with appendectomy becoming the most common emergency surgery.

We are now learning this was wrong.

New evidence suggests that appendicitis can be cured with antibiotics alone, avoiding surgery. Perhaps hospitalization can be avoided, too, like we manage some cases of acute diverticulitis.

Surgery became available in the late 1800s, and as anesthesia became more effective, appendectomy became routine. When antibiotics were introduced decades later, their use made appendectomy safer. The first clue that antibiotics could cure appendicitis came from experience among young submariners. However, it’s only been in the past few years that researchers have conducted studies in which patients with appendicitis were randomized to receive antibiotics first or urgent appendectomy.

There have been seven European randomized trials, the largest a study from Finland involving 530 participants with results published in JAMA.1 Adults with localized, uncomplicated appendicitis were enrolled. These trials found no increased rate of perforation or sepsis, and there have been no reported deaths in the antibiotics groups. Participants treated with antibiotics returned to their normal activities one to two weeks sooner than those treated with appendectomy. However, about 10 percent initially failed to improve, requiring surgery, as did about another 15 percent who had recurrence over the next year, totaling a 25 percent subsequent appendectomy rate overall. Similar findings have been reported in children from studies in which treatment was not randomized but guided by parent and patient preference.

This year, our group at Olive View-UCLA Medical Center reported our findings on the first US randomized trial in the Annals of Emergency Medicine.2 This study, funded by the National Institutes of Health, was a pilot study of 30 patients with imaging-confirmed, acute, uncomplicated appendicitis. This study’s innovation was the premise that standard postoperative milestones for hospital discharge—clinical stability, oral intake, pain control, and ability to follow up—should be applied to both groups, including the antibiotics group, even when met as early as during the ED stay. We initially gave a dose of long-acting parenteral antibiotic ertapenem to ensure active treatment while the patient’s bowel infection was recovering. Then we had the patients complete a 10-day antibiotics course with oral cefdinir and metronidazole, and we prescribed around-the-clock ibuprofen and prn oxycodone.

Pages: 1 2 3 | Single Page

Topics: Abdominal and GastrointestinalAntibioticsAppendectomyAppendicitisED Critical CareEmergency DepartmentEmergency MedicineEmergency PhysiciansOutcomePatient CareResearchSurgeryTreatment

Related

  • Reflecting on Four Decades at ACEP’s Council

    June 28, 2025 - 0 Comment
  • ACEP4U: Reinventing Research Education

    June 11, 2025 - 0 Comment
  • June 2025 News from the College

    June 5, 2025 - 1 Comment

Current Issue

ACEP Now: July 2025

Download PDF

Read More

2 Responses to “Antibiotics May Be Effective for Managing Appendicitis”

  1. April 30, 2017

    Robert Bostic, PA-C, HMC(SS) USN RET Reply

    Great article.

    The use of iv abx in the treatment of appendicitis, is the mainstay of treatment used by Independent Hospital Corpsmen in Submarine Service since the early 1980’s. Diagnosis was done by physical exam and lab studies, with treatment started on high probability cases. Due to the nature of operations, often sailors were not able to be medivac’d until after symptoms and treatment resolve. We used a 3 drug protocol of ampicillian, cipro, flagyl with excellent results. Most of sailors treated with this protocol, subsequently under went elective appendectomy, due to the nature of submarine operations.

  2. May 7, 2017

    Lee Morissette, PA-C, HMCM(SW), USN Ret Reply

    Agreed a great article and the subject of antibiotic use for appendicitis in the United States has been long in coming. As mentioned in the article and posted prior by a reader, fellow PA and former IDC, in the Navy we have long used antibiotics for acute appendicitis treatment, with no significant adverse outcomes. Even if there was a perforation, the patient was stabilized until they could be medevac’d to surgeon. Diagnosis was made on detailed physical exam and a manual CBC as no imaging available on all but larger ships. I personally had several Sailor’s with acute appendicitis that did exceptionally well with the 3 drug regiment previously mentioned.

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603