Dodging the knife?

Can physicians really treat a surgical condition? Take appendicitis for example. Assuming that it’s uncomplicated, the physician might give antibiotics to try and settle it down, whereas the surgeon will get in there and just take it out. The latter approach is the current standard of care – so could an antibiotic save you going to theatre?

This relatively small French study in the Lancet this month compares giving amoxycillin with clavulanic acid vs. sending the patient for an emergency appendicectomy. In the 123 patients on the antibiotics, significantly more had peritonitis within the following month, and the recurrence rate was over a quarter in the following year. What’s more, in the group randomised to surgery, even though they were screened with CT, almost a fifth had complicated peritonitis when they were opened up. 

Of course, amoxycillin/clavulanic acid may not be everyone’s choice here, depending on patterns of resistance, and the article’s first and last authors are both from the surgical department. That aside, considering the low mortality of the operation and the lack of sensitivity for complicated appendicitis on imaging, it would be reasonable to leave this in the hands of the surgeons. 

Check out the article over here



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