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Antibiotics Appendicitis

Antibiotics For Appendicitis Treatment - antibiotics appendicitis therapy - appendicitis treated with antibiotics - Appendicitis Antibiotics Used - Appendicitis Antibiotics Versus Surgery

Appendicitis is a condition in which your appendix becomes inflamed and fills with pus. Your appendix is a finger-shaped pouch that projects out from your colon on the lower right side of your abdomen. This small structure has no known essential purpose, but that doesn't mean it can't cause problems.

The appendix is a closed-ended, narrow tube up to several inches in length that attaches to the cecum (the first part of the colon) like a worm. (The anatomical name for the appendix, vermiform appendix, means worm-like appendage.) The open central core of the appendix drains into the cecum. The inner lining of the appendix produces a small amount of mucus that flows through the open central core of the appendix and into the cecum. The wall of the appendix contains lymphatic tissue that is part of the immune system for making antibodies. Like the rest of the colon, the wall of the appendix also contains a layer of muscle, but the layer of muscle is poorly developed.

Symptoms of Appendicitis

The main symptom of appendicitis is abdominal pain. The pain is at first diffuse and poorly localized, that is, not confined to one spot. (Poorly localized pain is typical whenever a problem is confined to the small intestine or colon, including the appendix.) The pain is so difficult to pinpoint that when asked to point to the area of the pain, most people indicate the location of the pain with a circular motion of their hand around the central part of their abdomen. A second, common, early symptom of appendicitis is loss of appetite which may progress to nausea and even vomiting. Nausea and vomiting also may occur later due to intestinal obstruction.

As appendiceal inflammation increases, it extends through the appendix to its outer covering and then to the lining of the abdomen, a thin membrane called the peritoneum. Once the peritoneum becomes inflamed, the pain changes and then can be localized clearly to one small area. Generally, this area is between the front of the right hip bone and the belly button. The exact point is named after Dr. Charles McBurney--McBurney's point. If the appendix ruptures and infection spreads throughout the abdomen, the pain becomes diffuse again as the entire lining of the abdomen becomes inflamed.

Causes of Appendicitis

The cause of appendicitis isn't always clear. Sometimes appendicitis can occur as a result of:

  • An obstruction. Food waste or a hard piece of stool (fecal stone) can block the opening of the cavity that runs the length of your appendix
  • An infection. Appendicitis may also follow an infection, such as a gastrointestinal viral infection, or it may result from other types of inflammation.
In both cases, bacteria inside the appendix multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture.

Appendicitis Treatment

Once a diagnosis of appendicitis is confirmed, the necessary treatment is usually surgery. In some cases, if the diagnosis is uncertain, the doctor may prescribe antibiotics as treatment if he or she is unsure whether the symptoms are being caused by appendicitis or something else, such as an infection.

In some cases, infections may cause the same symptoms as appendicitis. Therefore, if an appendicitis diagnosis is uncertain, people may be watched and sometimes receive antibiotics. If the cause of the pain is an infection, symptoms should resolve with intravenous antibiotics and intravenous fluids. However, if the patient has appendicitis, the condition cannot be treated with antibiotics alone and will require surgery.

Occasionally, the body is able to control an appendiceal perforation (a hole) by forming an abscess. An abscess occurs when an infection is walled off in one part of the body. The doctor may choose to drain the abscess (as part of appendicitis treatment) and leave the drain in the abscess cavity for several weeks. An appendectomy may be scheduled after the abscess is drained.

Antibiotics may treat appendicitis
Antibiotics rather than surgery may be a better treatment for cases of appendicitis in which the appendix has not yet burst, the results of a new study indicate.

Appendicitis is a painful infection in the area of the lower right abdomen that typically affects younger people aged 10 to 30. According to US researchers, the findings suggest that non-perforating appendicitis, as the disease is called when the appendix has not burst, may be unrelated to perforating appendicitis, in which the appendix has burst.

Instead, the study found that non-perforating childhood appendicitis, which historically has been treated with emergency surgery, seems to be a disease similar to non-perforating adult diverticulitis, which is often treated with antibiotics.

Diverticulitis refers to the swelling or inflammation of an abnormal pouch (diverticulum) in the intestinal wall. These pouches are usually found in the large intestine (colon). Symptoms can include abdominal pain, fever and nausea.

The researchers from Dallas analysed 27 years worth of hospital discharge records and found that childhood appendicitis and adult diverticulitis share many similarities, including an association with colon hygiene and a low intake of fibre in the diet.

The team analysed all the data and found ‘the same thing in every region'.

"It is assumed, but has never been proved, that appendicitis always perforates unless appendectomy is performed early in its course. There is a growing body of evidence to suggest that this is not the case.

"Childhood appendicitis and adult diverticulitis seem to be similar diseases, suggesting a common underlying pathogenesis. At least for appendicitis, perforating disease may not be an inevitable outcome from delayed treatment of non-perforating disease. If appendicitis represents the same pathophysiologic process as diverticulitis, it may be amenable to antibiotic rather than surgical treatment," the researchers said.

They noted that the findings ‘seem incompatible with the long-held view that perforating appendicitis is merely the progression of non-perforating disease where surgical intervention is delayed too long'.

Antibiotic Medications for Appendicitis

  • imipenem-cilastatin(Primaxin IV , Primaxin IM)

  • metronidazole(Flagyl , others...)

  • ciprofloxacin(Cipro , others...)

  • ampicillin(Principen , Omnipen)

  • clindamycin(Cleocin HCl , others...)

  • gentamicin(Garamycin )

  • levofloxacin(Levaquin , Levaquin Leva-Pak)

  • cefoxitin(Mefoxin )

  • piperacillin-tazobactam(Zosyn , Pipercillin Sodium-Tazobactam Sodium)

  • cefazolin(Ancef , Kefzol)

  • cefotetan(Cefotan )

  • ampicillin-sulbactam(Unasyn )

  • ertapenem(Invanz )

  • ticarcillin-clavulanate(Timentin )

Appendicitis Treatment with Antibiotics
One of the options for managing mild to moderately severe appendicitis that is unlikely to be associated with major perforation of the appendix and complications is treatment with antibiotics but no surgery. Patients often resolve their inflammation with antibiotics alone, but it has not been clear how many respond to antibiotics alone and what happens to them in the longer term, that is, over the ensuing weeks, months, or years. Specifically, does appendicitis recur and/or is surgery ultimately required?

A Swedish study looked specifically at these questions. The study randomized 252 men ages 15-50, to surgery or antibiotic treatment alone, excluding patients with a high suspicion of major perforation or complications. The antibiotic-treated patients received intravenous antibiotics for two days and then were switched to oral antibiotics for 10 days. Antibiotic-treated patients who did not respond within 24 hours to the antibiotics went to surgery immediately.

Fifteen antibiotic-treated patients did not respond to antibiotics alone (12% of patients) and went to surgery immediately. The numbers of patients who experienced a major perforation identified at the time of surgery were the same in the surgery-treated group and the antibiotic treated group, 5%, suggesting that waiting 24 hours to see if antibiotics alone would work did not lead to more perforations. Most of the antibiotic-treated patients (88%) recovered without surgery, demonstrating that antibiotics are very effective for treating mild to moderate appendicitis. Within the following five years, however, almost one-quarter (24%) of the patients who responded to antibiotics alone developed a second episode of appendicitis with most of the recurrences during the first year. (All of the recurrences were treated with surgery.)

A rate of recurrence of 24% is not high, but it also is not negligible. How can the findings of this study be used? First, the findings suggest that if there are reasons to postpone surgery, antibiotics alone are a satisfactory way to treat mild to moderate appendicitis without complications. Whether or not a 24% rate of recurrence is enough reason to undergo elective surgery--after the appendicitis has resolved with antibiotics alone and before it has a chance to recur--probably will be a choice made by individual patients. For some, the risk of recurrence will be acceptable and they will not opt for elective surgery. For others the risk will be too great not to undergo elective surgery. It is important to remember that the results of this study apply only to younger patients (ages 15-50) with mild to moderate, uncomplicated appendicitis. Although the study was limited to men, there is no reason to believe that the results would be different in women.

Antibiotic Therapy Versus Appendectomy for Acute Appendicitis
Appendectomy is the most frequent intra-abdominal operation performed, accounting for the majority of admissions in a general surgery unit. Appendectomy has always been considered the cornerstone in the treatment of acute appendicitis.Nevertheless, the idea of a conservative treatment using antibiotics is not that recent. Current practices have proven the efficiency of antibiotic therapy in treating certain infectious abdominal conditions including: appendicular mass with or without periappendicular abscess and acute diverticulitis. This success has prompted the researchers to consider the exclusive use of antibiotic therapy in the treatment of non complicated appendicitis.

In patients with clinical suspicion of acute appendicitis (localized abdominal tenderness, inflammatory reaction...etc) a CT scan will be performed to confirm the diagnosis of non complicated appendicitis. This diagnosis is confirmed on the CT in the absence of any sign of either localized peritonitis, and/or perforation (extraluminal gas, appendicular abscess, or phlegmon).

After a thorough explanation of this study, the patient will be obliged to sign a written consent. Patients will be randomly assigned to either one of the two therapeutic modalities : an appendectomy,or an antibiotic treatment consisting of amoxicillin and clavulanate potassium.

This therapy will be continued until the normalisation of leucocytic count and C reactive protein are achieved. In order to demonstrate equivalent conclusive results comparing the two treatment modalities, the statistical consultant estimated the inclusion of at least 200 patients in the study. However, after considering the possible loss of a number of patients following their inclusion for a variety of reasons, it was decided that a total of 250 patients will be enrolled.

Rate of intra abdominal infections in both therapeutic strategies is the first endpoint to be compared. Duration of pain, diet, hospitalisation, absence from work will also be compared. In the group of patients treated by antibiotics, the rate of persistant and recurrent appendicitis after treatment will be evaluated. Recurrent appendicitis is not considered a complication as long as the recurrence of the appendicitis is uncomplicated. During the followup period of one year, long-term complications will be observed including: abdominal hernia, adhesive intestinal occlusion, and others.

Antibiotics and appendicitis in the pediatric population, Appendicitis
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