Avoid Surgery and Hospitalization: Study Finds That Antibiotics Can Treat Appendicitis

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The study found that outpatients missed fewer workdays (2.6 vs 3.8) and had a comparable frequency of return health care visits as inpatients.

The researchers found that antibiotics are often effective in treating patients with appendicitis.

According to a recent study, outpatient antibiotic management of selected appendicitis patients is safe, enabling many patients to avoid surgery and hospitalization, and should be explored as part of the doctor-patient shared decision-making process.

This research is a continuation of the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial, which showed that antibiotic treatment was not inferior to urgent appendectomy. Following the experiment, the American College of Surgeons declared that high-quality evidence suggested that antibiotics may be used to treat the majority of patients.

The researchers looked at data from 726 people who had imaging-confirmed appendicitis and were given antibiotics at 25 different hospitals between May 1, 2016, and February 28, 2020.

Within 24 hours, 46% of the 726 participants who were randomly assigned to receive antibiotics were released from the emergency room. In the week after release, outpatient management was linked with less than one serious adverse effect per 100 patients.

Outpatient management was shown to be safe across a wide range of patients and was done in up to 90% of antibiotic-treated patients across all study sites. Compared to hospitalization, outpatient management was not associated with any more subsequent appendectomies and patients missed fewer workdays.

The researchers believe that outpatient management of appendicitis is safe for many people and could decrease healthcare use and costs.

Reference: “Analysis of Outcomes Associated With Outpatient Management of Nonoperatively Treated Patients With Appendicitis” by Writing Group for the CODA Collaborative, 1 July 2022, JAMA Network Open.
DOI: 10.1001/jamanetworkopen.2022.20039

Dr. David Talan, professor of emergency medicine and of medicine/infectious diseases at the David Geffen School of Medicine at UCLA, is co-principal investigator of the CODA Trial. The trial comprised dozens of researchers across the U.S., including UCLA investigators from the departments of surgery and emergency medicine at Olive View-UCLA Medical Center and Harbor-UCLA Medical Center: Dr. Dan DeUgarte, Dr. Gregory Moran, and Dr. Amy Kaji.

The study was funded by the Patient-Centered Outcomes Research Institute.

The authors disclosed financial ties to the pharmaceutical industry.

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