Antibiotics may be a good choice for some, but not all, patients with appendicitis, according to results from the Comparing Outcomes of Antibiotics and Appendectomy (CODA) trial. Reported today in the New England Journal of Medicine.
“About 3 out of 10 patients in the antibiotic group ultimately underwent appendectomy within 90 days,” he said. david frum, co-principal investigator and professor and associate chair of surgery at the University of Washington School of Medicine. “Each treatment has advantages and disadvantages, and patients will value these treatments differently based on their unique characteristics, concerns, and perspectives.”
coda This is the largest clinical randomized trial of appendicitis treatment in history. At hospitals in 14 states, 1,552 appendicitis patients agreed to participate and were randomly assigned to receive antibiotics first or appendectomy.
Almost half of the patients in the antibiotic group were discharged from the emergency department and avoided hospitalization for initial treatment, although the overall time spent in hospital was similar in both groups.
“Patients treated with antibiotics had more frequent emergency department visits, but they missed less time from work or school,” said Bonnie Bizzell, chair of the CODA Patient Advisory Committee. “Such information could be important as individuals consider the most appropriate treatment for their circumstances. The CODA trial captures these measures for shared decision-making regarding appendicitis. This is actually the first of its kind in this type of test.”
“When we compared the results of people treated with antibiotics alone to those who had appendectomies, we found that people who received either treatment felt better within 30 days.” said lead researcher Dr. David Taran, professor of emergency medicine and medicine. /Infectious Diseases at the David Geffen School of Medicine, University of California, Los Angeles. “In terms of overall health, antibiotics are no worse than surgery, and most people were able to avoid surgery in the short term,” Taran said.
[Download the soundbites below of Dr. Giana Davidson discussing the CODA Trial.]
In CODA, initial treatment with antibiotics appeared to pose a higher risk for patients with appendicoliths (calcified deposits within the appendix). This radiographic finding is seen in approximately one-quarter of patients with acute appendicitis and is associated with increased complications, with a four-in-ten chance of appendectomy by 90 days.
was funded by Patient-Centered Outcomes Research Institute (PCORI), the CODA study was conducted by a collaborative network of 25 hospitals. A collaborative research team of site clinicians, patient advisors, and other stakeholders will continue to share study results until ongoing follow-up with participants is completed.
Dr. Gianna DavidsonAn associate professor of surgery at the University of Wisconsin School of Medicine, he led clinical coordination for the U.S. sites participating in the CODA trial. She will present her findings today at the American College of Surgeons Clinical Meeting.
###
Editor’s note:
- Downloadable infographic of CODA results
- Requests for an interview with Bonnie Bizzell of CODA’s Patient Advisory Committee should be directed to Brian Donohue (contact information above).
- A complete list of CODA collaborating institutions, researchers and media contacts is available here.
Thank you for your sharing. I am worried that I lack creative ideas. It is your article that makes me full of hope. Thank you. But, I have a question, can you help me?