An RCSI study conducted at Beaumont Hospital in Dublin has found that surgery, rather than just antibiotics, should remain the primary treatment for uncomplicated acute appendicitis.
Published in the History of treatments and led by researchers from RCSI University of Medicine and Health Sciences, the study called the COMMA (Conservative Against Open Control of uncomplicated acute appendicitis) trial examined the efficacy and quality of life associated with treatment antibiotic only on uncomplicated acute appendicitis versus surgical intervention. . The results showed that treatment with antibiotic alone resulted in high recurrence rates and lower quality of life for patients.
Uncomplicated acute appendicitis is a common surgical condition. In the traditional management of the condition there is surgery to remove the appendix (appendectomy). Antibiotic-only treatment has emerged as an alternative that could bring benefits to patients and hospitals, such as faster recovery, less scaring, less pain, better quality of life for patients and reduced demand for theaters. Reliance on antibiotic-only treatment has been relied upon due to previous research that has shown wide variability in failure rates and a lack of evidence regarding the impact on patients ’quality of life.
In this study, 186 patients with radiological evidence of chronic, uncomplicated appendicitis were randomized to two groups. One group received antibiotic-only treatment and patients in the other group were treated with surgery. Patients in the surgical group underwent laparoscopic appendectomy. In those treated with antibiotics alone, intravenous (IV) antibiotics were administered until patient signs and symptoms improved and this was followed by five days of oral antibiotics.
In the weeks and months after treatment, patients were followed up with questionnaires including a quality of life questionnaire at 1 week, 1 month, 3 months and 12 months. At these points, the patient’s pain score, the need for additional sick leave, surgical site infections and the development of recurrent appendicitis were determined.
The results from the antibiotic group alone showed that 23 patients (25%) developed acute appendicitis within a year. In the quality of life questionnaires, patients in the surgical group were found to have a much better quality of life score compared to the antibiotic-only group.
Antibiotic-only treatment of uncomplicated acute appendicitis is recommended as a less invasive alternative treatment for patients. The COMMA Test aimed to determine whether antibiotic-only treatment could replace surgery in some cases, which could have many benefits for both patients and hospitals. The results indicate that the treatment protocols should not be changed. Surgery will give patients the best results in terms of quality of life and recurrence and so they should remain the primary treatment for uncomplicated acute appendicitis. “
Professor Arnold Hill, Head, School of Medicine and Professor of surgery, RCSI
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Magazine Reference:
O’Leary, DP, et al. (2021) A randomized clinical trial evaluating the efficacy and quality of life of antibiotic-only treatment on uncomplicated acute appendicitis results of a COMMA trial. History of treatments. doi.org/10.1097/sla.000000000000004785.