In this episode, I’ll discuss a recent trial on surgery vs antibiotics for appendicitis.
The question of whether some patients with appendicitis can be treated with antibiotics alone as an alternative to surgery is controversial.
In an effort to bring clarity to this subject, a Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis was published in October 2020 in the New England Journal of Medicine.
The study was a nonblinded, noninferiority, randomized trial that compared a 10-day course of antibiotic therapy with appendectomy in patients with appendicitis at 25 U.S. centers. The primary outcome was 30-day health status, and secondary outcomes included appendectomy in the antibiotics group and complications through 90 days.
Over 1500 patients were divided evenly between groups. Almost half of the patients in the antibiotic group were not hospitalized during treatment and nearly all of the patients in the surgery group had a laparoscopic procedure.
Nearly one-third of patients in the antibiotics group needed an appendectomy by 90 days and complications were more than twice as common in the antibiotics group than in the appendectomy group.
Despite these findings related to complications and the need for surgery, antibiotics were non-inferior to appendectomy on the basis of the primary outcome looking at 30-day health status.
While the primary outcome indicated non-inferiority, an accompanying editorial in the same issue of the journal urged caution in choosing antibiotics over surgery. It is likely that surgery will still be considered first-line for most patients after this study, but antibiotics may be an option depending on patient-specific circumstances.
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