Antibiotics are as effective as surgery in some cases of appendicitis.

A comparison of antibiotic drug and appendectomy (CODA) results showed that 1,552 patients with appendicitis participated in 25 hospitals in 14 states.

Participants in an open-label, non-inferiority trial were randomized to undergo an appendectomy or first take a 10-day course of antibiotics.

Antibiotics were given intravenously for at least 24 hours before switching to oral medication.

The main result was 30 days of health. Secondary outcomes included appendectomy of the antibiotic group and 90 days of complications.

Of those who received antibiotic treatment, 30% had an appendectomy within 90 days. The risk of complications and appendectomy was higher in those who had the appendix, a calcified deposit of the appendix.

People in the antibiotic group returned to the emergency room more often. However, the overall time at the hospital was similar between the two groups. People treated with antibiotics have less time to miss work or school.

Overall, antibiotic treatment was found to be no less than appendectomy.

The additional results of the CODA trial will be shared over the next two years.

Dr. Kemperry He is an emergency physician and assistant medical director of the Trident Emergency Department at the Trident Medical Center in Charleston, South Carolina.

Perry told Healthline that appendicitis is a diagnosis he must make on a daily basis.

“Appendectomy is classically a very common operation, and over the years there have been few secondary speculations. With such a study at NEJM, doctors provide better guidance to patients, It can help patients get the treatment that best suits their condition, “says Perry.

“There are other diagnoses. Diverticulitis, That changed the way we think about appendicitis, “he added.

Diverticula are small bags that form along the gastrointestinal tract and can subsequently become infected.

“The appendix is ​​not formed in the same way because it is an organ / structure of its own, but both can be infected with similar bacteria in a similar way. Clinicians are accustomed to antibiotics for diverticulitis. So there is at least a precedent for a similar treatment plan, “says Perry.

Dr. John S. Kennedy He is a general surgeon at DeKalb Surgical Associates and a staff member at Emory Hospital in the Atlanta area. In fact, for 33 years he has taken care of hundreds of people with appendicitis, treated with antibiotics and treated with surgery.

Kennedy said half of the 8,168 patients with appendicitis evaluated were excluded for a variety of reasons. He also observed that the study did not include children.

“Since the diagnosis was basically made by what the CT scan showed, some patients may not even need antibiotics (CT scans can be false positives),” Kennedy said on the health line. Told to.

“Follow-up was only 90 days, so the number of patients who eventually avoided surgery is arguably less than 70%,” he said.

appendicitis An infection or inflammation of the appendix.

The pain begins around the navel and may move to the lower right abdomen. You may also have tenderness, nausea, and vomiting in the abdomen. Seek medical attention immediately if you have symptoms of appendicitis.

Untreated appendicitis can cause serious complications.Appendix can be rupture It leaks bacteria and pus into the abdominal cavity.this is Potentially A life-threatening event.

Perry advises people to consider the risks of each treatment plan.

“If antibiotics do not treat the infection properly, there is always a risk of the appendix rupturing. Surgery is not without its own risk. This study describes the risk / benefit profile of either treatment plan. It enables better discussions with patients, “he continued.

Kennedy also suggests that people also think about how sick they are.

“If I’m a patient, not very soft, have no fever or vomiting, and have a high white blood cell count, I think I’ll skip surgery,” he said.

“If you have complex appendicitis at diagnosis, you probably need surgery. If you are given antibiotic options, is it okay if you have a 30% or greater chance of needing surgery later?” Kennedy continued. ..

Kennedy advises, taking into account the failure rate of antibiotics in the presence of appendiceal stones Appendectomy In these cases.

He said surgeons also need to consider the following:

• Other conditions that cause pain in the lower right quadrant
• Schedule flexibility for those who have started using antibiotics but need or need appendectomy
• Whether the patient complies with the required follow-up when treated with antibiotics

Antibiotics help some people avoid surgery, but it’s not for everyone.

“Some surgeons feel that the 30%” failure rate “of antibiotics is too high, and they disagree with that. Also, some patients are worried that the surgeon they just met may not be able to offer the best treatment without surgery, “says Kennedy.

Perry said that for now, the general practice is still to remove the appendix.

“Even in this study, which is fairly convincing that antibiotics are a viable treatment plan, it will be difficult to convince patients and their doctors to adopt only antibiotics for appendicitis,” Perry said. It was.