New survey results published in JAMA Surgery showed that most people would choose surgery over antibiotics alone for treating appendicitis in themselves or their child. However, almost 10% would opt for antibiotics alone, suggesting that healthcare providers should discuss this option with patients.

Patients should be presented with all viable treatment options, including antibiotics alone, while future research on antibiotic treatment for appendicitis should focus on improving failure rates. Noting that some surgeons resist treating with antibiotics alone, they added that surgeons should offer antibiotics to patients with appendicitis while feeling comfortable explaining why they prefer surgery.

The traditional management for appendicitis includes surgery, with minimally invasive laparoscopic surgery increasingly used as a replacement for open surgery. New research suggests that antibiotics alone can eliminate the need for surgery in some people. Yet studies also suggest that antibiotics alone may increase the risk for longer hospitalization, outpatient treatment, treatment failure, and complications.

Discussing these treatment options as well as the risks and benefits of each is important for informed decision making. To assess how patients might choose between these options, Hanson and colleagues conducted an anonymous online survey between April 2016 and June 2016. The survey included 1728 individuals recruited via social media, email, and postering.

It asked respondents to imagine that they or their child had acute uncomplicated appendicitis; described the risks for open surgery, laparoscopic surgery, and antibiotics alone; and asked them which treatment they would choose and their reasons for doing so. Results showed that 85.8% (n = 1482) of respondents chose laparoscopic surgery for themselves, whereas 4.9% (n = 84) chose open surgery and 9.4% (n = 162) chose antibiotics alone.

When asked which option they would choose for their child, 79.4% (n = 1372) chose laparoscopic surgery, 6.1% (n = 106) chose open appendectomy, and 14.5% (n = 250) chose antibiotics alone. Because so few people chose antibiotics alone, researchers surveyed an additional 220 people to try to understand what might influence their choice for antibiotics.

Results suggested that decreasing short-term failure and long-term recurrence rates might make antibiotics alone more appealing. Further research is needed on how to reduce failure and recurrence rates with antibiotics alone, the authors conclude.