Study shows antibiotics may be viable treatment option for appendicitis


Date:
October 6, 2020
Source:
Henry Ford Health System
Summary:
In the largest randomized US study of appendicitis, researchers
report that seven in 10 patients who received antibiotics avoided
surgery and that patients who took antibiotics for symptom relief
fared no worse in the short term than those who underwent surgery.



FULL STORY ========================================================================== Every year more than 250,000 people undergo surgery for appendicitis,
making it one of the 20 most common surgeries performed in the United
States.


==========================================================================
In the largest randomized U.S. study of appendicitis published today
in the New England Journal of Medicine, researchers from Henry Ford
Health System and 24 other sites around the U.S. report that seven in
10 patients who received antibiotics avoided surgery and that patients
who took antibiotics for symptom relief fared no worse in the short term
than those who underwent surgery.

Still, researchers cautioned that taking antibiotics for appendicitis
is not for everyone and advised patients to consult with their physician.

"The significance of this study means that surgeons and patients now
have more options for the treatment of appendicitis," says J.H. "Pat"
Patton, M.D., medical director of Surgical Services for Henry Ford Health System and a study co-investigator. "We now know that we can safely
and effectively treat a significant number of patients with antibiotics
alone and avoid surgery. We encourage patients to weigh their options
based on their individual circumstances before deciding which treatment
is best for them." Henry Ford was among 25 U.S. sites in 14 states that participated in the study, Comparing Outcomes of Antibiotic Drugs and Appendectomy (CODA). With 1,552 patients studied between May 3, 2016
and Feb. 2, 2020, CODA represents the largest study comparing surgery
and antibiotics in adults with appendicitis and is roughly three times
larger than the previous one. The study was funded by the Patient-Centered Outcome Research Institute.

Unlike prior studies, CODA was the first to include patients with severe appendicitis and a condition called appendicolith, in which a small
stone forms in the appendix. Researchers originally planned to report
their findings after patients recovered for one year. With concern about limiting unneeded surgeries during the height of the COVID-19 pandemic, researchers decided to reduce the time frame for reporting results
following either surgical or antibiotic intervention to 90 days in order
to give physician data on the effectiveness of this non-surgical option.



==========================================================================
Key findings of the study:
* Seven in ten patients who received antibiotics avoided surgery
within the
first 90 days following treatment, while three in ten did eventually
need surgery within the same time frame
* Four in ten patients with an appendicolith who received antibiotics
required surgery within 90 days of receiving antibiotics as their
first treatment
* Patients treated with either antibiotics or surgery experienced
symptoms
of appendicitis for about the same amount of time prior to treatment
* Patient treated with antibiotics missed less time from work or
school but
reported more visits to the Emergency Department and days spent
in the hospital overall than those who had surgery
Researchers acknowledge that the study's timing in the middle
of a pandemic could have broad implications for both patients and
hospitals. Risk of COVID-19 exposure or going to a hospital continues
to be a real concern for patients who may find antibiotic treatment a
preferred choice. The study also provides hospitals with clarifying
options as they prepare for a possible surge of COVID-19 cases this
fall and winter. Because of health care disparities highlighted in
the pandemic, Dr. Patton cautions that doctors be mindful of properly addressing vulnerable patient populations on the implications of the
study.

"We recognize some patients may not want to come into a hospital
environment during a pandemic. This study tells us that antibiotics
are a viable option for some of these patients," Dr. Patton says. "And
as the data are starting to show, patients who are COVID positive and
undergo general anesthetic may have more complications than they may
otherwise have. If we can treat patients successfully on an outpatient
basis, we can keep them out of the hospital and preserve resources for
other types of surgeries." Jeffrey Johnson, M.D., medical director of
Trauma at Henry Ford Hospital and co-investigator on the CODA trial,
recommends that patients assess all their options with their doctor.

"Beyond the treatment itself, patients need to fully explore their medical condition and personal factors like time off from work and school,
insurance coverage and caregiving responsibilities when making their
decision," Dr.

Johnson says. "What this study shows is there is no one-size-fits-all
approach.

Patients ought to evaluate the benefits and risks of taking antibiotics
or opting for surgery and make an informed decision on what is
important to them." An appendectomy is the standard treatment for
treating appendicitis and most patients recover quickly and without complications. The procedure is performed laparoscopically or by
one incision and involves surgically removing the appendix, a small
tube-shaped pouch that is attached to the large intestine in the lower
right side of the abdomen. Severe abdominal or stomach pain, low- grade
fever and loss of appetite are classic symptoms. An overnight hospital
stay is typical for most patients.



==========================================================================
In the study 776 patients were randomly assigned to receive antibiotics
and 776 patients to undergo appendectomy (776). Patients' median age was
38 and 63 percent were men and 37 percent women. The ethnic background was
60 percent white, 23 percent other, 5 percent Asian, 2 percent American
Indian or Alaska Native and 1 percent Native Hawaiian or Pacific Islander.

Patients in the antibiotics group received a 10-day course of antibiotics
based on guidelines from the Surgical Infection Society and Infectious
Diseases Society of America.

Of the 1,552 patients, 172 were enrolled at Henry Ford Hospital, the
health system's hospital in Detroit.

Researchers will be reporting on additional findings from data that
continues to be collected from patients. Future analysis will examine
long-term quality of life, recurrence of appendicitis in the antibiotics
group and predictors of outcomes based on patient characteristics among
other topics.


========================================================================== Story Source: Materials provided by Henry_Ford_Health_System. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. The CODA Collaborative. A Randomized Trial Comparing Antibiotics
with
Appendectomy for Appendicitis. NEJM, 2020 DOI: 10.1056/NEJMoa2014320 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/10/201006114251.htm

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