University of Iowa Hospitals and Clinics is one of 25 clinics across the U.S. to participate in a national trial that, so far, shows antibiotics could be an alternative to surgery for treating appendicitis.  

UIHC is participating in Comparing Outcomes of Antibiotic Drugs and Appendectomy. Trial Site co-leader at UIHC Dionne Skeete said the hospital had 156 of the 1,552 participants enrolled with appendicitis.

Because of Iowa’s population and UIHC joining the study halfway through the trial, Skeete said UIHC has a smaller number of patients in the study.

UI Clinical Assistant Professor in the Department of Emergency Medicine Brett Faine, who co-leads with Skeete, said comparing treatments for appendicitis has been a controversial question and has not formally been studied in the U.S. before the current trial.

The early results of the study were published in the New England Journal of Medicine this week.

“This trial included all patients with all levels of severity for appendicitis,” Faine said. “So, it really provided the best evidence we have ever had.”

So far, he said antibiotics were found to be an alternative to an appendectomy as a treatment.

The trial found that three out of 10 patients who received antibiotics underwent an appendectomy within 90 days, Skeete said. The patients who took antibiotics also experienced the same symptoms for an equal amount of time compared to patients who had surgery, she said.

Chair of the study’s Patient Advisory Board Bonnie Bizzell said patients who had an appendicolith – a stone-like deposit in the appendix – had worse outcomes when taking antibiotics.

Skeete said it is up to the patient to weigh the pros and cons of their personal situation to determine if they want to take antibiotics or get surgery for an appendicitis treatment.

“The benefit of surgery is that you know you get the appendix taken out and then you do not have to worry about appendicitis ever again,” Skeete said. “But the downside is that it’s surgery. So, there is a risk. The benefit of antibiotics is that, you know, you get a dose of an antibiotic and you avoid surgery. You get better without having to have that kind of operation.”

The treatment option of antibiotics allows more flexibility for clinics when something such as COVID-19 stresses hospital availability, Faine said.

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“Being in the middle of the pandemic, if operating rooms have to be shut down, or as we saw earlier because of the pandemic, if operating capacity has to be limited, antibiotics do seem to be suitable options,” he said.

The trial gave attention to preventing selection bias within the criteria that patients had to meet to be a part of the study. Skeete said previous studies of the same kind excluded women as a part of the study population.

Bizzell said that patient engagement was a large part of the trial.

“I think, what else makes it very unique is that the CODA Trial included patients that had not been included before and in other trials that looked at, comparing antibiotics to surgery,” she said.

The last patient’s trial was enrolled and completed in January, Skeete said, but the study will be finishing up for the next two years. The team will look for the rate of complication during the follow up.

“We are still going to do the follow up to see if the group is having adverse effects,” Faine said. “… But, overall, antibiotics versus surgery were not inferior to the improvement outcomes.”