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

David R. Flum, M.D., M.P.H., 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 U.S. centers. A total of 1,552 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 percent confidence interval, −0.001 to 0.03). In the antibiotics group, by 90 days, 29 percent had undergone appendectomy, including 41 and 25 percent of those with and without an appendicolith, respectively. Complications occurred more often in the antibiotics group than the appendectomy group (8.1 versus 3.5 per 100 participants; rate ratio, 2.28; 95 percent confidence interval, 1.30 to 3.98); the higher rate was attributed to those with an appendicolith (20.2 versus 3.6 per 100 participants; rate ratio, 5.69; 95 percent confidence interval, 2.11 to 15.38).

“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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