Going to the pool table in the event of an appendicitis attack is not systematic. According to a recent American study, a course of antibiotics could be sufficient in seven out of ten cases – or at least make it possible to delay the operation.
In the event of an attack of appendicitis in adults, the standard treatment practiced for decades is appendectomies – in other words, the removal of this organ by means of a surgical intervention. However, this could be avoided in 7 out of 10 cases, and replaced by course of antibiotics.
In any case, this is what the first results of a study presented today at the American College of Surgeons Clinical Congress 2020 reveal, and published online on the site of the New England Journal of Medicine. This randomized clinical trial called CODA was conducted in 25 American medical centers, with 1,552 adults suffering from appendicitis.
Antibiotic treatment: an alternative treatment for appendicitis
After three months of research, scientists found that the health of patients on antibiotics was not worse, a month later, than that of patients whose appendix had been removed. They therefore believe that this data could significantly change the treatment of appendicitis in the United States.
“For the first time, these results will inform American patients with appendicitis about the options available to them and the expected results”, enthuses David R. Flum, associate professor of surgery at the UW School of Medicine and co-author of the study, alongside David Talan, an emergency medicine physicist at UCLA’s Geffen School of Medicine.
Work that agrees with previous European studies
Over the past 25 years, several European studies had already shown the effectiveness of antibiotic treatments, for most patients with appendicitis. However, less than 5% of Americans who suffer from it are currently receiving non-surgical treatment.
Indeed, many American doctors believed that this work was lacking. The CODA test was therefore intended to fill the latter, in particular by answering certain questions centered on the patient. It was a question of knowing, for example, to what extent taking medication affects the time of hospitalization and sick leave, compared to appendectomy.
7 times out of 10, antibiotic therapy is as effective as appendectomy
More specifically, the researchers randomly divided the patients into two groups. The first half suffered a appendicectomie. The second was prescribed a cure of 10 days of antibiotics, administered intravenously during the first 24 hours, then as tablets for the remaining days.
Thirty days later, patients’ health had improved in both groups. In addition, each treatment had its own advantages and disadvantages. For example, 3 out of 10 patients may still need to be operated on, three months after the drug treatment. In case d’appendicolite (a more severe form of appendicitis), the risk of complications also appears to be higher in patients treated with antibiotics.
This treatment reduces the time spent in hospital and sick leave
However, simply taking antibiotics helped prevent 47 % of patients to be hospitalized. This group also missed 3.4 days less work than operated patients. In addition, general anesthesia is never trivial; benefiting from a safe and effective alternative in at least 7 out of 10 cases is therefore good news.
In view of these results, Dr Flum specifies that “antibiotic treatment will be good for many people, but not for everyone”. Patients with appendicitis need a individualized treatment, which best meets their condition and needs. The type of treatment used will therefore be determined on a case-by-case basis.