Antibiotics are currently an accepted first-line treatment for most people with appendicitis, according to the final results of the Comparing Outcomes of antibiotic Drugs and Appendectomy (CODA) trial, published today in The New England Journal of Medicine, and the updated treatment guide for appendicitis of the American College of Surgeons.

“In the first three months after taking antibiotics for the condition, nearly 7 in 10 patients in the antibiotic group avoided an appendectomy. By four years, just under 50% had the surgery,” explains David Flum, co-principal investigator and professor at the Faculty of Medicine of the University of Washington.

Together, they add, these results show that “antibiotics appear to be the appropriate treatment for many, but probably not all, patients with appendicitis.”

CODA is the largest randomized clinical trial ever conducted on the treatment of appendicitis. It has been carried out in 25 hospitals in 14 US states, with 1,552 patients with appendicitis who were randomly assigned to receive antibiotics or undergo an appendectomy.

People with appendicitis know that it is one of the most common urgent surgical conditions and they usually come after a few days of abdominal pain, nausea, vomiting, and sometimes fever.

“While there were advantages and disadvantages to each treatment, we found that both treatments are safe, and patients will likely value these outcomes differently based on their unique symptoms, concerns and circumstances,” says Flum.

The study shows that patients with an appendicolith, a calcified deposit found in approximately 25% of cases of acute appendicitis, had more complications and a greater likelihood 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 new treatment guidelines, it is important for surgeons and patients to discuss the pros and cons of both surgery and antibiotics in deciding on the treatment that’s best for that person at that time,” adds Dr. Giana Davidson, professor of the University of Washington.

Image Credit: Getty

You were reading: Antibiotics for appendicitis, better than surgery in most cases