Can Antibiotic Therapy Be as Good as Appendectomy in the Treatment of Appendicitis?

A study published in the New England Journal of Medicine compared the use of antibiotics in the treatment for appendicitis instead of performing an appendectomy. Although both options were successful in treating appendicitis, the study shows that 7 in 10 patients who were given antibiotics ultimately avoided surgery.

Co-principal investigator Dr. David Flum said that about three in 10 patients in the antibiotic group underwent an appendectomy procedure within 90 days.

The Comparison of the Outcomes of antibiotic Drugs and Appendectomy, or CODA, offers the largest study to date comparing the use of antibiotics to appendectomy in patients with appendicitis. Their goal is to help nearly 300,000 people, who visit the hospital annually due to appendicitis-related issues, find the best treatment suitable for them as evidenced in this study.

The CODA trial

The CODA Trial is funded by the Patient-Centered Outcome Research Institute and has 1,552 participants enrolled from 25 sites in 14 states. According to Flum, each treatment has its own advantages and disadvantages, and participants value these differently based on their unique characteristics, preferences, and concerns.

Participants from both groups reported the same general health one month after treatment.

Nearly half of the participants from the antibiotics group were discharged from the emergency department and avoided hospitalization for their initial treatment, but the study shows that the overall time spent in the hospital was similar in both groups.

Bonnie Bizzell, chair of the CODA patient advisory board, said that those treated with antibiotics more often returned to the emergency department, but spent less time away from work and school. 

This kind of information helps individuals consider their best treatment options based on their unique circumstances. The CODA trial is the first of its kind to capture these measures for shared decision-making about appendicitis.

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The Outcome of the study

71% of those belonging to the antibiotics group did not undergo surgery within three months and only missed around 3 1/2 days at work. However, 9% of participants from this group needed another trip to the emergency room or required urgent health care within three months, as compared to only 4% in the surgery group. 

This is because, with a successful appendectomy, the appendix is fully removed. But with antibiotic therapy, appendicitis may recur. It is due to this that researchers needed to determine how often this happens in follow-up reports.

Participants with an appendicolith, calcified deposit within the appendix, experienced a higher rate of problems in the antibiotics group. They were at higher risk for appendectomy within three months at 41%, as compared to the overall group rate for participants using antibiotics of 29%.

Understanding the Appendix

The appendix is a small pouch, around four inches long, that sits at the junction of the small and large intestine. Its function is unknown but there's a theory suggesting the appendix as the storehouse for good bacteria, which helps reboot the digestive system after diarrheal illnesses. There are other experts who believe the appendix is just a useless remnant from our evolutionary past as performing surgical removal of the appendix does not cause any observable health problems.

Appendicitis is when your appendix becomes inflamed or infected, this is considered a medical emergency as there is a serious risk of your appendix bursting or rupturing within 48 to 72 hours after developing symptoms. Without the proper medical procedures, it may lead to peritonitis, a life-threatening infection in your belly.

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