Antibiotics vs. Surgery for Appendicitis: What Long-Term Research in the UK and Sweden Shows
Scientists at University College London have found that many people with appendicitis who choose antibiotics instead of an operation tend to do well over the long term. This non-surgical route is suitable for more than half of patients in certain cases. The findings were published in JAMA Surgery, underscoring a growing body of evidence about when antibiotics can safely stand in for immediate surgery.
The researchers analyzed data from approximately 300 Swedish patients who experienced appendicitis. Between 1992 and 1996, some patients underwent surgical removal while others received antibiotic therapy. Follow-up information was available for about 260 individuals, with some participants tracked for as long as 26 years after their initial appendicitis episode. This extended perspective offers valuable insight into the durability of non-surgical treatment over decades.
During the study, around one in ten patients treated with antibiotics at some point still needed medical care for abdominal pain later on. This rate mirrored the operated group, suggesting that antibiotic treatment can be safe and effective for many patients in the long term. However, roughly 30% of those who started with antibiotics eventually required an appendix removal later in the course of their illness. These figures help doctors weigh initial treatment choices against the potential for future intervention.
Researchers noted the importance of understanding gut bacteria as it relates to appendicitis and other gut health issues. As knowledge about the microbiome advances, there may be long-term benefits to protecting and preserving this portion of the digestive system. Protecting gut health is a consideration when evaluating treatment options for appendicitis, especially as newer evidence emerges about how antibiotics interact with the body’s microbial communities. [Citation: JAMA Surgery study, UCL researchers]
For patients who fear surgery or who carry higher anesthetic risks, non-surgical treatment with antibiotics can be a practical option to discuss with clinicians. In particular, older adults or those with significant comorbidities may benefit from avoiding an immediate operation when appropriate. The choice between antibiotics and surgery should be personalized, taking into account the patient’s overall health, symptom severity, and the likelihood of recurrence. [Citation: JAMA Surgery study, UCL press release]
Antibiotics entered routine use for appendicitis in the 1990s, offering a less invasive alternative to surgery. Earlier studies followed patients for five years or less, which limited long-term conclusions. The current study helps bridge that gap by providing data that extends well beyond a decade, reinforcing confidence in antibiotic therapy as a viable option for selected patients. It also highlights the need for ongoing monitoring and follow-up to catch any late developments that may require intervention. [Citation: JAMA Surgery study]
In summary, the evolving picture of appendicitis treatment shows that antibiotics can work for a significant share of patients without immediate surgery. The long-term results from this multinational observation suggest that many patients can avoid surgery without compromising safety or efficacy, while others may still require it later. As medical teams weigh options, they can integrate this evidence with individual risk profiles and patient preferences, aiming for outcomes that minimize discomfort, recovery time, and hospital visits. [Citation: JAMA Surgery study, long-term follow-up data]
Overall, the conversation about appendicitis treatment continues to evolve with new microbiome research and long-term outcome data. Clinicians in North America and beyond are increasingly comfortable discussing antibiotic therapy as a legitimate alternative when appropriate, rather than defaulting to surgery for every case. As always, seeking timely medical advice and following personalized care plans remains essential for achieving the best possible results. [Citation: JAMA Surgery study, international clinical guidance]