CODA trial shows antibiotics may be a good choice for certain patients with appendicitis

Reviewed by Emily Henderson, B.Sc.Oct 6 2020

Antibiotics may be a good choice for some, but not all, patients with appendicitis, according to results from the Comparing Outcomes of antibiotic Drugs and Appendectomy (CODA) Trial reported today in the New England Journal of Medicine.

The findings indicated that antibiotics were not worse than surgery when measuring overall health status, allowing most people to avoid an operation in the short term.

Boston Medical Center, one of 25 hospitals nationwide where the CODA Trial was conducted, recruited the greatest number of patients among the three New England CODA sites and was in the top third for patient recruitment overall.

"There were advantages and disadvantages to both treatments, and patients are likely to prioritize these in different ways based on their own unique characteristics and interests," said F. Thurston Drake, MD, MPH, a general and endocrine surgeon at Boston Medical Center (BMC) who served as co-site lead for CODA at BMC.

"As a surgeon, I can play an important role in helping patients choose the treatment options that are best for their individual situation and health needs."

While nearly half of the antibiotics group avoided hospitalization for their initial treatment, overall, the time spent in the hospital was similar between groups.

People treated with antibiotics more often returned to the emergency department but missed less time from work and school. Information like this can be important for individuals as they consider the best treatment option for their unique circumstance. The CODA Trial is really the first of its kind to capture these measures for appendicitis shared decision-making."

Bonnie Bizzell, Chair of Patient Advisory Board, Comparing Outcomes of antibiotic Drugs and Appendectomy

The CODA Trial, which was funded by the Patient-Centered Outcomes Research Institute (PCORI), is the largest randomized clinical trial of appendicitis conducted to date. Across the United States, 1,552 participants were randomized to receive appendectomy or antibiotics-first for uncomplicated appendicitis.

Other initial findings of the CODA Trial include:

• Patients treated with either surgery or antibiotics experienced symptoms of appendicitis for about the same amount of time.
• Approximately 3 out of 10 patients in the antibiotic group underwent appendectomy by 90 days.
• Patients with an appendicolith, a calcified deposit within the appendix, had twice the risk of complications than those without an appendicolith.
• Participants with an appendicolith had an increased chance of appendectomy by 90 days (4 in 10 with appendicolith vs 3 in 10 without).

"The results from this trial provide tremendous insight into how providers and patients can collaborate and develop treatment plans based on the options available and the needs of the patient," added Sabrina E. Sanchez, MD, MPH, a surgeon at BMC who co-led the BMC CODA trial site.

"Patients are key players when determining their care plans, and their insight can lead to tailored treatment options based on their specific needs, which can improve health outcomes."