A New Conversation in Appendicitis: Appendectomy or “Antibiotics First”

Wednesday, May 20, 2015

Appendicitis is the most common reason for emergency abdominal surgery—approximately 300,000 people undergo an appendectomy in the US each year. The advent of laparoscopic surgery has made the procedure safer and reduced complications. However, despite the safety and efficacy of appendectomy, there is still some uncertainty in the healthcare community around the necessity of appendectomy for managing appendicitis.

In a new article in the New England Journal of Medicine, CERTAIN Medical Director Dr. David Flum highlights the case for an “antibiotics-first” approach to treating appendicitis. In this treatment, appendectomy is performed only if the appendicitis is not resolved after a course of antibiotics. This approach has been successful in Navy personnel who developed appendicitis while at sea and did not have access to an operating room.  It has also been explored in some small randomized clinical trials in Europe.

Dr. Flum’s article has received considerable attention nationally. Within one week of publishing, it was featured in the New York Times, on Forbes.com, and on the Harvard Health Blog.  

While Dr. Flum does not advocate for one treatment approach over the other, he contends that an antibiotics-first strategy is an alternative that warrants consideration—particularly for patients who have had prior surgical complications or who might prefer to avoid surgery. Ultimately, Dr. Flum believes large multi-center trials are necessary to better understand the clinical outcomes, cost implications, and patient preferences of an antibiotics-first approach compared to prompt appendectomy.