Antibiotics for Appendicitis: Penny wise but pound foolish

By SAURABH JHA A Finnish group randomized patients with acute appendicitis to surgery and antibiotics and found that antibiotics were successful in 73 % of patients. Depending on how this is framed, you can celebrate a 70 % success or lament a 30 % failure. Much of the debate in healthcare is a battle of framing.The study has limitations. Finland is not just a land of the midnight sun but a land of fewer laparascopic surgeries than the USA. This is important because if done properly laparoscopic surgery has a lower morbidity than open surgery, as Skeptical Scalpel explains. Should we be excited that antibiotics can be used for acute appendicitis? Patients won’t need to be opened up. This will be a revolution. A paradigm shift. Right? May be. May be not. Here are my predictions if antibiotics become the first line treatment for acute appendicitis. a)      Incidence of Mild Early Subclinical Tip Appendicitis will increase, dramatically. Mild Early Subclinical Tip Appendicitis (MESTA) is a disorder which affects nearly all radiologists reading CAT scans for acute appendicitis at some point in their career. I suffered MESTA as a junior attending. I read a CAT scan in a young man with abdominal pain. The appendix was 6 mm. The size cut off for an abnormal appendix is 6 mm. Of course, nothing dramatically happens as the appendix increases from 5.99 mm to 6.01 mm. 6 mm is a threshold. A line must be drawn somewhere. The young man had an appendectomy. The surgeon emailed me...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: THCB Saurabh Jha Source Type: blogs