Appendectomy or Antibiotics for Acute Appendicitis? Latest on the CODA Trial

This transcript has been edited for clarity.

Robert D. Glatter, MD: Hi and welcome. I'm Dr Robert Glatter, medical advisor for Medscape Emergency Medicine.

The well-established standard treatment for acute appendicitis is surgical appendectomy. I think we can all agree on that. It's pretty clear. However, there's been a large amount of research in the past decade that's challenged the dominance of the surgical approach, looking at using antibiotics alone. Many of us are well aware of this.

The literature is really limited by important things. We should talk about these, such as exclusion of patients with appendicolith, a very small sample size, and also the predominance of using an open approach vs a laparoscopic approach. Certainly, the data and the studies are interesting, but we really need more data on this.

This is what the CODA (Comparison of Outcomes of antibiotic Drugs and Appendectomy) trial did. The New England Journal of Medicine study was published in November 2020 and compared antibiotics with appendectomy. The question they were asking was, in adult patients, are antibiotics not inferior to surgery for treatment of acute appendicitis?

Here to join me in this really important discussion is Dr Joseph Sakran, an acute care and trauma surgeon at Johns Hopkins Hospital, and Dr Ali Raja, executive vice chair of emergency medicine at Massachusetts General Hospital, Harvard Medical School.