Antibiotics versus appendectomy for appendicitis

To assess the efficacy of antibiotic therapy compared with appendectomy for the treatment of appendicitis, a noninferiority trial in 1,552 adults with appendicitis or an appendicolith was conducted at 25 centres in the USA. Patients were randomized to receive either a 10-day course of antibiotics or to undergo surgery. Antibiotics were noninferior to appendectomy, based on the primary outcome of 30-day European Quality of Life–5 Dimensions questionnaire scores (mean difference, 0.01 points; 95% CI −0.001 to 0.03). Of the antibiotics group, 41% of those with an appendicolith and 25% of those without had undergone an appendectomy by 90 days after randomization. Complications were more common in the antibiotics group than in the appendectomy group.


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  1. The CODA Collaborative. A randomized trial comparing antibiotics with appendectomy for appendicitis. N. Engl. J. Med. (2020)

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Correspondence to Jordan Hindson.

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Hindson, J. Antibiotics versus appendectomy for appendicitis. Nat Rev Gastroenterol Hepatol 17, 714 (2020).

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