What's unique about the CODA study?

Most patients with appendicitis in the United States had surgery to take out their appendix. In other countries, patients are often given the option of treatment with 10 days of antibiotics and only have surgery if the medicines do not work. Previously, most of the information we had about this option were from studies done in Europe. The CODA Trial is the largest study of treatments for appendicitis ever conducted among adults, and the first large-scale study to look at this question in the US. The results of this study have found that both treatments, antibiotics and surgery, are both great options to treat appendicitis.

If a patient chooses to take antibiotics for appendicitis, will they get appendicitis again?

Results of the CODA study found that antibiotics were as good as surgery. However, of the group of patients that got antibiotics, 3 in 10 patients had to have surgery within 90 days. By one year after first experiencing appendicitis, 4 in 10 patients who first took antibiotics had surgery to remove their appendix. 

In the group of patients that got antibiotics, nearly 5 in 10 received surgery to treat their appendicitis within 3 years, and most were diagnosed with appendicitis again in the first two years of receiving treatment. 

For patients who had antibiotics or an appendectomy for treatment of appendicitis, was there a difference in the amount of time patients spent in the hospital?

During the first visit, time spent in the ER or hospital was about the same in both groups.

CODA found that if a patient’s appendicitis is treated with antibiotics while they are in the emergency room, they might be able to go home the same day, or they might stay in the hospital for an extra day or two depending on how they feel. 

In the first month after receiving antibiotics, patients were readmitted to the hospital at a higher rate than those who had an appendectomy.

What is an appendicolith?

An appendicolith is a stone like structure in the appendix associated with a higher rate of complications and appendectomy when receiving antibiotics.

Can I still take antibiotics to treat my appendicitis if I have an appendicolith?

Yes, but it’s important to remember that patients with an appendicolith have nearly a double risk of an appendectomy within the first 48 hours after starting antibiotics. However, after 48 hours, the chance of getting an appendectomy is not greater than people who have an appendicolith.

If I have appendicitis again, can I try antibiotics again?

The CODA trial did not specifically test this, but some people did try antibiotics again. Other studies have shown that this is possible.

What type of patients do these study results apply to?

The CODA trial did not include the following people: people with advanced cardiac disease or liver disease. Therefore, antibiotics should not be offered to these people.

We are unsure of the effect of antibiotics on people with abnormal immune systems or pregnant women.