Taking antibiotics is just as effective for appendicitis as having an operation, major study finds


Having an operation to remove your appendix may become a thing of the past after a study found antibiotics are just as effective as the surgery.

Doctors split 1,500 patients who suddenly fell ill with appendicitis, which makes the organ swollen and painful, into two groups.

One received a course of antibiotics, while the others had their organ removed. 

More than 70 per cent of patients given antibiotics dodged surgery in the following three months, according to results of the University of Washington research.  

They endured fewer sick days off of work or school compared to participants who underwent surgery, spending less time in hospital overall. 

After one month of either antibiotics or surgery, patients rated their general health and symptoms such as pain or fever at an equal amount.

The first findings of the ‘Comparing Outcomes of antibiotic Drugs and Appendectomy Trial’ (CODA) suggest thousands of operations could be avoided with heavier use of antibiotics. 

And the scientists noted in their paper that antibiotics may become more standard as a treatment for appendicitis now that hospitals are stretched to deal with Covid-19 patients and a backlog of routine operations. 

Appendix removal could become a thing of the past because antibiotics are just as effective as having surgery, a study has found. Stock of appendix being removed

Appendix removal could become a thing of the past because antibiotics are just as effective as having surgery, a study has found. Stock of appendix being removed

Appendicitis occurs in around seven per cent of the UK and US population each year, but could be as high as 12 per cent. 

Inflammation of the appendix, a thin finger-like tube at the top of the colon, causes an intense pain in the lower right side of the body and sometimes constipation or diarrhoea. 

The most common route of treatment is surgery, called an appendectomy, to take out the appendix right away.

The NHS says: ‘If you have appendicitis, it’s likely your appendix will need to be removed as soon as possible.’

Figures suggest around 50,000 people in England are admitted to hospital with appendicitis each year, and 70,000 appendectomies are undertaken across the UK. 

WHAT IS APPENDICITIS?

Appendicitis is a swelling of the appendix, a two to four-inch-long organ connected to the large intestine.

Appendicitis can cause severe pain and it’s important for it to be treated swiftly in case the appendix bursts, which can cause life-threatening illness.

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In most cases surgeons will remove the appendix in an appendectomy – scientists aren’t sure why people need an appendix but removing it does not harm people.

The causes of appendicitis aren’t clear but it is thought to be caused by something blocking the entrance to the organ.

Symptoms include pain in the stomach which later travels to your lower right-hand-side and becomes severe. 

Pressing on this area, coughing, or walking can all make the pain worse, and other symptoms can be nausea, vomiting, loss of appetite, diarrhoea and a fever.

Source: NHS 

In 2014, more than 95 per cent of patients with appendicitis in the US were treated with an appendectomy, CODA says.   

During surgery, the appendix is removed from the body after doctors make three or four tiny incisions in the abdomen. The cuts are closed with staples or stitches.

After surgery, most patients go home by the next day and return to normal activities after about one week.

But as with any surgery, there are risks; around one in ten patients have problems such as a skin infection.

Six European studies have shown that most people with appendicitis can be treated successfully with antibiotics instead of having surgery, CODA reports.

CODA was set up to confirm such findings on a larger group of people, with 1,552 appendicitis patients across 14 states enrolling so far. 

Patients had been randomised to either have an appendectomy or antibiotics, which were at first given through a small plastic tube in the vein, called an IV, for 24 hours while the patient is in hospital with symptoms.

Once the patient went home, they kept taking antibiotic pills for a total of 10 days. 

The findings, published in the New England Journal of Medicine, show benefits and drawbacks for both treatment types. But that antibiotics could help avoid surgery all together.

Only three in ten patients had to return for surgery in the following three months, meaning seven in ten dodged the operation. 

Of those who did end up having surgery, 11 per cent had it within 48 hours, 20 per cent by 30 days, and in 29 per cent by 90 days. 

The paper acknowleddged that a lmitation of the study is that it only followed patients for three months, and some may have needed surgery – or suffered other complications – afterwards. The Covid-19 pandemic had limited their ability to follow patients for a year as planned.

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NHS PATIENTS WILL NEED TO PHONE AHEAD FOR A&E APPOINTMENTS THIS WINTER 

NHS 111 will become the ‘front door’ to A&E to stop the NHS being overwhelmed this winter.

Patients will be asked to call first and book an appointment to attend unless it is a life or death emergency, the Health Secretary announced on September 17.

Matt Hancock revealed the plans to expand the pilot schemes alongside a £150million funding boost to expand A&E departments at 25 hospitals.

New ‘urgent care hubs’ and ‘triage centres’ will be built and existing facilities redeveloped with more cubicles and larger waiting rooms in a bid to make them more Covid-19 secure.

Health bosses hope the changes will stop scenes of overcrowding this winter as the service grapples with the additional strain from coronavirus.

Mr Hancock said: ‘During the peak of the pandemic we saw millions of people using NHS 111 to get the best possible advice on Covid-19 and other urgent NHS services. 

‘These pilots will build on this and test whether we can deliver quicker access to the right care, provide a better service for the public and ensure our dedicated NHS staff aren’t overwhelmed.’

Pilot schemes are underway at five sites – in Cornwall, Portsmouth, Hampshire, Blackpool and Warrington – ahead of a national rollout in December.

NHS 111 call centre handlers will direct those with less serious health complaints to see a GP, visit a pharmacist or attend a minor injuries unit.

Patients deemed ill enough for emergency treatment will be given an appointment to attend when the unit is not too busy. Health officials stress that no one who turns up unannounced will ever be turned away.

Because the antibiotics did not work to keep the infection at bay for those 30 per cent of people, the risk of recurrence of illness is much higher in the antibiotic group compared with the surgery group. 

With the one-time treatment of appendix removal, patients rarely had to return to hospital – only four per cent needed to in the three months following. 

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The findings show nearly half (47 per cent) of the antibiotics group avoided hospitalisation for their initial treatment compared with 95 per cent in the surgery group who needed to be admitted following their operation.

But the overall time spent in the hospital was similar between both groups. 

Participants in the antibiotic group missed an average of 5.3 days from work or school compared with 8.7 days in the appendectomy group due to differences in recovery. 

Bonnie Bizzell, chair of the CODA patient advisory board, said: ‘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 shared decision-making about appendicitis.’

‘When we compared the outcomes of people treated with antibiotics alone or surgery to remove the appendix, we found that people receiving either treatment felt well at 30 days,’ said Dr David Talan, co-principal investigator and professor of emergency medicine and medicine/infectious diseases at the David Geffen School of Medicine at UCLA.

‘In terms of overall health status, antibiotics were no worse than surgery and allowed most people to avoid an operation in the short term,’ he said. 

Scientists conducting the trial were most interested in the patients’ health 30 days after their treatment, finding similar levels of rated symptoms in the two groups. 

Dr David Flum, co-principal investigator and professor and associate chair of surgery at the University of Washington School of Medicine, said: ‘There were advantages and disadvantages to each treatment, and patients will value these differently based on their unique characteristics, concerns, and perspectives.’  

The researchers wrote in their paper: ‘With the pandemic of coronavirus disease 2019 (Covid-19), health systems and professional societies such as the American College of Surgeons have suggested reconsideration of many aspects of care delivery, including the role of antibiotics in the treatment of appendicitis.’



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