HealthDay News – Antibiotics are noninferior to appendectomy for treatment of appendicitis, according to a study published online October 5 in the New England Journal of Medicine to coincide with the annual clinical congress of the American College of Surgeons, held virtually from October 3 to 7.

David R. Flum, MD, MPH, from the University of Washington in Seattle, and colleagues conducted a noninferiority, randomized trial comparing a 10-day course of antibiotic therapy to appendectomy in patients with appendicitis at 25 US centers. A total of 1552 adults were randomly assigned: 776 to receive antibiotics and 776 to undergo appendectomy.

The researchers found that on the basis of 30-day European Quality of Life-5 Dimensions questionnaire scores, antibiotics were noninferior to appendectomy (mean difference, 0.01 points; 95% confidence interval, −0.001 to 0.03). In the antibiotics group, by 90 days, 29% had undergone appendectomy, including 41 and 25% of those with and without an appendicolith, respectively. Complications occurred more often in the antibiotics group than the appendectomy group (8.1 vs 3.5 per 100 participants; rate ratio, 2.28; 95% confidence interval, 1.30 to 3.98); the higher rate was attributed to those with an appendicolith (20.2 vs 3.6 per 100 participants; rate ratio, 5.69; 95% confidence interval, 2.11 to 15.38).

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“These data may be particularly relevant during the COVID-19 pandemic, as patients and clinicians weigh the benefits and risks of each approach, considering individual characteristics, preferences, and circumstances,” the authors write.


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