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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, November 12, 2020

Antibiotics vs Appendectomy for Appendicitis

REBEL Cast Ep 89 - November 12, 2020 - By Salim Rezaie
"Background: The well-established, standard treatment for acute appendicitis is surgical appendectomy. However, recent research has challenged the dominance of the surgical approach in looking at antibiotics alone. The available literature on non-operative treatment of appendicitis (NOTA) has important limitations: exclusion of patients with appendicoliths, small sample size and predominance of open appendectomy over laparoscopic appendectomy. While data on NOTA is intriguing, it is clear that additional studies are needed.
Paper: The CODA Collaborative. A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis. NEJM 2020. PMID: 33017106
Clinical Question: In adult patients, are antibiotics noninferior to surgery for the treatment of acute appendicitis?
Author Conclusion: “For the treatment of appendicitis, antibiotics were noninferior to appendectomy on the basis of results of a standard health-status measure. In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith.”
Clinical Take Home Point: Although an antibiotic 1st strategy was non-inferior in this trial compared to appendectomy, nearly 3 in 10 patients had undergone appendectomy by 90 days, there were 3x more ED visits, and 2x more complications (This could be balanced with less days of missed work). Patients with an appendicolith are at a much higher risk of complications and need for surgery and in these patients an antibiotic 1st strategy should not be recommended."