Antibiotics may be a good treatment choice for some appendicitis patients, according to early results from the Comparing Outcomes of antibiotic Drugs and Appendectomy (CODA) trial reported in the New England Journal of Medicine.
Seven in 10 patients who received antibiotics avoided surgery in the first 90 days and fared as well in the short term as those who underwent surgery, researchers at Rush University Medical Center and 24 other hospitals across the United States reported. Patients whose condition included an appendicolith, a calcified deposit within the appendix, had a higher risk of complications and an increased chance of having an appendectomy in the first 90 days than patients without an appendicolith, according to the study.
“The findings can help patients and physicians work together in choosing the right treatment,” said surgeon Thea Price, MD, assistant professor, Rush Medical College, and the study’s principal investigator for Rush University Medical Center.
In terms of the patients’ overall health status, the antibiotics were not worse than surgery in the short term.
“This is important information for patients who are weighing the advantages and disadvantages of both treatments, especially with the current pandemic,” Dr. Price said. “We used this protocol earlier this year when surgeries were generally being avoided, and the results supported the study’s published outcomes.”
In the ongoing trial, 1,552 participants were randomized to receive appendectomy or antibiotics-first for uncomplicated appendicitis.
The CODA trial is the largest randomized clinical trial of appendicitis conducted to date. Across the United States, 1,552 participants were randomized to receive appendectomy or antibiotics-first for uncomplicated appendicitis.
While nearly half of the antibiotics group avoided hospitalization for their initial treatment, overall, the time spent in the hospital was similar between groups in the first 90 days.
“The CODA trial is really the first of its kind to capture these measures for appendicitis shared decision-making,” says Bonnie Bizzell, Chair of the CODA Patient Advisory Board.
The CODA researchers will continue to follow up with the participants and share results from the trial, which is being funded by the Patient-Centered Outcomes Research Institute (PCORI).
Other initial findings of the CODA trial include:
- Patients treated with either surgery or antibiotics experienced symptoms of appendicitis for about the same amount of time.
- People treated with antibiotics more often returned to the emergency department but missed less time from work and school.
- Approximately 3 out of 10 patients in the antibiotic group underwent appendectomy by 90 days.
- Patients with an appendicolith, a calcified deposit within the appendix, had twice the risk of complications than those without an appendicolith.
- Four in 10 patients whose condition included an appendicolith had an appendectomy within the 90 days, compared to three in 10 without the calcified stone.