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A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis.

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  • 1The affiliations of the members of the writing committee are as follows: the University of Washington (D.R.F., G.H.D., S.M., A.K.S., E.F., D.C.L., B.A.C., P.J.H., L.G.K.), the Washington State Hospital Association (B.B.), Harborview Medical Center (H.E., J.C.), the Swedish Medical Center (K.A.M.), and the Virginia Mason Medical Center (J.T.Y., A.W.), Seattle, Madigan Army Medical Center, Tacoma (V.S., K.M.), and Providence Regional Medical Center Everett, Everett (C.S.F., S.M.S.) - all in Washington; Beth Israel Deaconess Medical Center (N.I.S., S.R.O.) and Boston University Medical Center (S.E.S., F.T.D.) - both in Boston; Columbia University Medical Center (K.F.), Tisch Hospital, NYU Langone Medical Center (P.A.-C., W.C.), Bellevue Hospital Center, NYU School of Medicine (P.A.-C., W.C.), and Weill Cornell Medical Center (R.J.W., S.C.) - all in New York; Henry Ford Health, Detroit (J.J., J.H.P.), and the University of Michigan, Ann Arbor (H.B.A., P.K.P.); University of Iowa Hospitals and Clinics, Iowa City (B.A.F., D.A.S.); the University of Texas Lyndon B. Johnson Medical Center (M.K.L.) and the University of Texas Health Science Center at Houston (L.S.K.) - both in Houston; the University of Mississippi Medical Center, Jackson (M.E.K.); Maine Medical Center, Portland (B.C., D.W.C.); Ohio State University Medical Center, Columbus (A.R., S.S.); Rush University Medical Center, Chicago (T.P.P.); UCHealth University of Colorado Hospital, Denver (L.F., M.S.); Harbor UCLA Medical Center (D.A.D., A.H.K.), Olive View UCLA Medical Center (G.J.M., D.S., A.K.), and Ronald Reagan UCLA Medical Center (D.A.T.) - all in Los Angeles; and Vanderbilt University Medical Center, Nashville (C.M.T., W.H.S.).

The New England Journal of Medicine
|October 5, 2020
PubMed
Summary
This summary is machine-generated.

Antibiotic therapy is a viable alternative to surgery for appendicitis, showing similar health status outcomes. However, nearly 30% of patients treated with antibiotics eventually required surgery, especially those with an appendicolith.

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Area of Science:

  • General Surgery
  • Infectious Diseases
  • Clinical Trials

Background:

  • Antibiotic therapy is increasingly considered as a non-surgical option for treating appendicitis.
  • This study evaluates the efficacy and safety of antibiotic treatment versus appendectomy for appendicitis.

Purpose of the Study:

  • To compare 30-day health status between antibiotic therapy and appendectomy for appendicitis.
  • To assess secondary outcomes including rates of subsequent appendectomy and complications within 90 days.

Main Methods:

  • A pragmatic, nonblinded, noninferiority randomized trial involving 1552 adult patients across 25 U.S. centers.
  • Patients were randomized to a 10-day course of antibiotics or appendectomy.
  • Health status was measured using the European Quality of Life-5 Dimensions (EQ-5D) questionnaire; subgroup analyses were conducted based on the presence of an appendicolith.

Main Results:

  • Antibiotics were noninferior to appendectomy regarding 30-day health status (mean difference 0.01 points on EQ-5D).
  • By 90 days, 29% of patients in the antibiotic group underwent appendectomy, with higher rates in those with an appendicolith (41%) compared to those without (25%).
  • Complications were more frequent in the antibiotic group (8.1%) than the appendectomy group (3.5%), particularly in patients with an appendicolith (20.2%).

Conclusions:

  • Antibiotic therapy is a noninferior alternative to appendectomy for appendicitis based on health status.
  • A significant proportion of patients treated with antibiotics, especially those with an appendicolith, may require subsequent appendectomy.
  • While generally safe, antibiotic treatment is associated with a higher complication rate, particularly in patients with an appendicolith.