No surgery for appendicitis? Scientists conclude they can treat condition with antibiotics

SEATTLE, Wash. — Appendicitis can be an extremely painful condition which almost always ends in surgery. Now, however, researchers from the University of Washington School of Medicine say medical science has reached the point where doctors no longer have to take out your appendix when this occurs. The results of the largest-ever clinical trial on appendicitis treatments finds antibiotics can help the majority of patients avoid an appendectomy.

The findings come from the Comparing Outcomes of antibiotic Drugs and Appendectomy (CODA) trial as well as a brand new treatment guideline from the American College of Surgeons. In total, 25 hospitals across 14 states participated in the CODA trial, treating 1,552 patients with appendicitis.

“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,” says co-principal investigator Dr. David Flum, the associate chair of surgery at UW School of Medicine, in a university release. “Other outcomes favored either antibiotics or surgery. Putting it all together, antibiotics look to be the right treatment for many, but probably not all, patients with appendicitis.”

The group consented to receiving one of two random treatments for their condition, either antibiotics or the standard appendectomy.

What is appendicitis?

Appendicitis is an inflammation of the appendix, which scientists consider a vestigial organ that serves no purpose in modern day humans. Most patients experience this between the ages of 10 and 30. They’ll experience a sudden pain that begins on the right side of their lower abdomen. The pain will grow as the inflammation worsens.

If the appendix ruptures, it can spread infection throughout the abdomen, causing life-threatening complications. In these cases, doctors must remove the appendix.

“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,” Flum adds.

Antibiotics just as good as surgery after 30 days

For people with an appendicolith, a calcified deposit doctors find in about a quarter of acute appendicitis cases, the study finds these patients suffered more complications during the first 30 days of treatment. They also had a higher chance of antibiotics not working and needing surgery during this time.

However, if a patients with an appendicolith made it through the first month on antibiotics, their chances of needing surgery after 90 days dropped to normal levels.

“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,” says Dr. Giana Davidson, an associate professor of surgery and director of the CODA trial’s clinical coordinating center.

Which treatment works best for you?

CODA investigators have created an online tool to help patients figure out which treatment option best fits — antibiotics or surgery.

“In the emergency setting, patients with appendicitis can make a treatment decision hurriedly,” Davidson concludes. “This online tool was built to help communicate the CODA results in laymen’s terms, and to spur a conversation between patients and surgeons about potential benefits and harms of each approach.”

The CODA study findings appear in the New England Journal of Medicine.

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