Antibiotics or Surgery for Acute Appendicitis? - AV HOSPITAL

Antibiotics or Surgery for Acute Appendicitis?

The standard treatment followed till today for Acute Appendicitis was surgery.

The meta-analysis conducted by Harnoss and colleagues combined eight studies involving 2551 patients with appendicitis. They found that while approximately 3 out of 4 patients were successfully treated with antibiotics, there was considerable difference in rates of antibiotic treatment failure .The recurrence of appendicitis rate after antibiotic therapy ranged from 0% to 53% for initial failure and 11% to 60% for recurrence of appendicitis by one year.

The CODA (Comparing Outcomes of Drugs and Appendicectomy) Trial Focussed on Identifying the Best Approach.

CODA is a trial with a goal of randomly assigning 1552 patients at up to 16 sites of practice across the United States to either antibiotics or appendectomy for the treatment of most cases of acute appendicitis.

CODA focuses on both clinical outcomes and patient-reported outcomes including healthcare-related quality of life, work productivity, missed school, future healthcare burden, and decisional regret. The follow-up period is at least 2 years. Evaluations of appendectomy specimens reveal an approximately 1% rate of incidental neoplasm, representing tumours that may be left behind in patients treated with antibiotics. This is a critical area to consider before antibiotics are offered as part of usual care because, among the 300,000 patients treated for appendicitis each year, a rate of 0.6% unremoved neoplasm would affect close to 2000 people.

After the trial it is concluded that Appendectomy should be considered over Antibiotics. Beyond the existing evidence gaps, there are compelling reasons to hesitate before offering antibiotics to patient with appendicitis. Perhaps the best reason is that appendectomy is a safe and effective procedure that is curative of the illness.

A.V.Hospital routinely performs appendicectomy by Laparoscopic approach. The duration of stay in the hospital is 1 day. Laparoscopic Appendicectomy is associated with less pain, less bleeding, early return to work and also offers cosmesis as the cuts made are just 1cm and 5mm.

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