Antibiotic Treatment for Acute Appendicitis Safe for Most Patients

The use of antibiotics for patients with acute appendicitis is a safe treatment option for people seeking a nonoperative alternative to care, according to a recent study.

Thank Using findings from the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial, the authors looked to examine the efficacy and safety of antibiotics in the outpatient management of acute appendicitis.

The authors conducted a randomized, cohort study that included 776 adults diagnosed with appendicitis and confirmed through imaging. The patients received antibiotics at 25 hospitals across the United States between May 2016 to February 2020. Outpatient management and hospitalization were defined here as “discharge within or after 24 hours, respectively.”

Of the total patients, 5.4% (n = 42) underwent an appendectomy, and 1.0% (n = 8) did not receive their first antibiotic dose within 24 hours of hospitalization. A total of 726 patients received antibiotics for treatment, of which 335 patients were discharged within 24 hours (46.1%), and 391 were discharged after 24 hours (53.9%). The authors took note of serious adverse events that occurred among patients receiving outpatient vs inpatient care. Over 7 days, adverse events occurred in 0.9 per 100 outpatients (95% CI, 0.2 – 2.6), and 1.3 per 100 inpatients (95% CI, 0.6 – 7.9).

Additionally, appendectomy occurred in 9.9% of outpatients (95% CI, 6.9% - 13.7%), and 14.1% of inpatients (95% CI, 10.8% - 18.0%). At 30 days, 12.6% (95% CI, 9.1% - 16.7%) of outpatients received appendectomies compared with 19.0% (95% CI, 15.1% - 23.4%) of inpatients who received the surgery. Outpatients also had fewer missed workdays than inpatients, and had a similar frequency of return health care visits and satisfaction scores.

It appears that most patients who choose antibiotics can avoid hospitalization without incurring [an] increased risk of serious complications or appendectomy,” the authors concluded. “Outpatient management should be included in shared decision-making discussions of patient preferences for outcomes associated with nonoperative and operative care.”


—Jessica Ganga


Talan D, DeUgarte D, Moran G, Kaji A; Writing Group for the CODA Collaborative. Analysis of outcomes associated with outpatient management of nonoperatively treated patients with appendicitis. JAMA Netw Open. Published online July 1, 2022. doi:10.1001/jamanetworkopen.2022.20039.