Antibiotics are now an accepted first-line treatment for most people with appendicitis. This is based on the final results of the Comparing Outcomes of antibiotic Drugs and Appendectomy (CODA) trial and an updated treatment guide for appendicitis from the American College of Surgeons.
Taken together, antibiotics appear to be the appropriate treatment for many
“In the first three months after taking antibiotics for the condition, nearly 7 out of 10 patients in the antibiotic group avoided an appendectomy. At four years of age, just under 50% underwent surgery ”. Said Dr. David Flum, co-principal investigator and professor and associate chair of surgery at the University of Washington (UW) School of Medicine.
“Other results favored antibiotics or surgery. Taken together, antibiotics appear to be the appropriate treatment for many. But probably not for all appendicitis patients. “
Both treatments are safe
CODA is the largest randomized clinical trial ever conducted on the treatment of appendicitis.
In 25 hospitals in 14 states, 1,552 appendicitis patients gave their consent to participate. In addition, they were randomly assigned to receive antibiotics or undergo an appendectomy.
“While there were trade-offs to each treatment, we found both treatments to be safe, and patients will likely rate these results differently based on their unique symptoms, concerns, and circumstances,” said Flum.
At 90 days, there was no greater chance of appendectomy
Patients with appendicolith, a calcified deposit that is found in approximately 25% of cases of acute appendicitis. They were associated with more complications and a higher probability of appendectomy in the first 30 days.
However, at 90 days, there was no greater chance of appendectomy in patients with appendicolith.
“Given these results and the new treatment guidelines. It is important that surgeons and patients discuss the pros and cons of surgery and antibiotics to decide the best treatment for that person at that time. So said Dr. Giana Davidson. She is an associate professor of surgery at the University of Washington and director of the clinical coordinating center for the CODA trial.
CODA researchers created an online decision-making tool for patients.
To foster those conversations, CODA researchers created an online decision-making tool for patients. It includes a video and a mechanism to help patients choose the direction that best suits their individual circumstances.
“In emergency situations, patients with appendicitis can make a treatment decision quickly,” Davidson said. “This online tool was created to help communicate CODA results in simple terms and to stimulate a conversation between patients and surgeons about the potential benefits and harms of each approach.”
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