Materiały źródłowe

• #1 Appendicitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543

  Appendicitis is an inflammation of the appendix. […] Treatment of appendicitis is usually antibiotics and, in most instances, surgery to remove the appendix. […] Once the infection is clear, the appendix can be removed surgically. In some people, the abscess is drained, and the appendix is removed immediately.

• #2 Appendicitis: Signs, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/158806

  Appendicitis refers to the inflammation of the appendix. It generally occurs when the appendix is blocked, which causes blood flow problems, inflammation, infection, and pressure. Without treatment, the appendix can burst. […] The NIDDK states that a doctor will prescribe antibiotics for anyone with appendicitis. […] In most cases, however, a surgeon must remove the appendix. This is called an appendectomy. […] According to a 2023 review and meta-analysis, although the cure rate is lower than with surgery, treatment with antibiotics may be an option for those with uncomplicated acute appendicitis who do not wish to have surgery. […] There are two methods for removing the appendix, which include: Laparoscopy: This is a precise procedure in which there is minimal loss of blood and only a small incision.

• #3 Management of acute appendicitis in adults – UpToDate

  https://www.uptodate.com/contents/management-of-acute-appendicitis-in-adults

  Management of acute appendicitis in adults […] For over a century, open appendectomy was the only standard treatment for appendicitis. Contemporary management of appendicitis is more sophisticated and nuanced: laparoscopic appendectomy has surpassed open appendectomy in usage, some patients with perforated appendicitis may benefit from initial antibiotic therapy followed by interval appendectomy, and several trials have even suggested that it is feasible to treat uncomplicated appendicitis nonoperatively with antibiotics alone. […] The management of appendicitis in adults will be reviewed here.

• #4 Acute Appendicitis: Symptoms, Diagnosis, and Treatment

  https://resources.healthgrades.com/right-care/appendectomy/acute-appendicitis

  Early appendectomy is the most effective treatment for acute appendicitis. Removing the appendix before it ruptures helps prevent serious complications such as peritonitis or abscess. […] Doctors often use a combination of medications and surgery to treat acute appendicitis. […] Doctors typically choose from two types of surgery to remove an inflamed appendix. […] Laparoscopic appendectomy: This procedure is a minimally invasive surgery that uses small incisions in the abdomen and camera-guided tools to remove the appendix. […] Open appendectomy: This procedure is more invasive surgery to remove the appendix and clean out the abdominal cavity. Doctors typically need to perform an open appendectomy if the appendix ruptures before removal. […] Getting prompt care for symptoms of acute appendicitis can reduce your risk of complications and allow for faster, more effective treatment.

• #5 Are Antibiotics the Answer to Treating Appendicitis? | ACS

  https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2024/april-2024-volume-109-issue-4/are-antibiotics-the-answer-to-treating-appendicitis/

  Managing uncomplicated acute appendicitis can involve two treatment pathwayssurgery or antibioticsand is a clinical decision that has been rigorously debated in recent years, driven by data from several prominent clinical trials. […] Surgical appendectomy has been the first-line option for treating uncomplicated appendicitis for more than 120 years, although nonoperative management may be a safe alternative for a select patient population. […] However, for some patients, particularly those who are not in a physical state that is conducive for surgery or are located in settings where resources are limited, such as during the COVID-19 pandemic, nonoperative management for uncomplicated appendicitis is a viable alternative. […] While the APPAC and CODA trials demonstrated that it is likely safe to treat the first episode of uncomplicated appendicitis with antibiotics, clinicians are advised to have honest and straightforward conversations with patients about potential recurrence rates.

• #6 Appendicitis Treatment & Management: Approach Considerations, Emergency Department Care, Nonsurgical Treatment

  https://emedicine.medscape.com/article/773895-treatment

  Appendectomy remains the only curative treatment of appendicitis, although nonoperative management is increasingly recognized as being safe and effective for uncomplicated cases of acute appendicitis. […] Antibiotics have an important role in the nonsurgical treatment of patients with acute appendicitis. […] Preoperative antibiotics have demonstrated efficacy in decreasing postoperative wound infection rates in numerous prospective controlled studies, and they should be administered in conjunction with the surgical consultant. […] Nonsurgical treatment may be useful when appendectomy is not accessible or when it is temporarily a high-risk procedure. […] The early appendectomy group had shorter hospitalization stays, received fewer parenteral antibiotics, underwent fewer radiologic studies and other invasive procedures (percutaneous drainage, central venous catherization), and had fewer inpatient febrile episodes, as well as had fewer postadmission intraabdominal complications and/or fewer unscheduled postdischarge readmissions.

• #7 Appendicitis | Signs, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/a/appendicitis

  Antibiotics: If the appendix has not burst, treatment with only antibiotics may be possible. Your doctor will talk to you if this is an option. […] Most kids with appendicitis will need surgery to remove the infected appendix. […] Treatment is different for a burst appendix compared to one that has not burst. […] All patients will get IV antibiotics before surgery. […] Only patients with a burst appendix will get IV antibiotics after surgery. […] Surgery will be done in one of three ways: One incision through the belly button this is more common if the appendix has not burst. […] Three port surgery three small incisions are made in the belly. […] Open appendectomy this is very rare. It is usually done in cases where the appendix burst a few days before the surgery and the inside of the belly is very infected (called peritonitis).

• #8 Appendicitis Medication: Penicillins, Cephalosporins, Aminoglycosides, Carbapenems, Fluoroquinolones, Anti-infective Agents, Analgesics

  https://emedicine.medscape.com/article/773895-medication

  The goals of therapy are to eradicate the infection and to prevent complications. Thus, antibiotics have an important role in the treatment of appendicitis, and all such. Agents under consideration must offer full aerobic and anaerobic coverage. The duration of the administration is closely related to the stage of appendicitis at the time of the diagnosis. […] Antibiotic agents are effective in decreasing the rate of postoperative wound infection and in improving outcome in patients with appendiceal abscess or septicemia. The Surgical Infection Society recommends starting prophylactic antibiotics before surgery, using appropriate spectrum agents for less than 24 hours for nonperforated appendicitis and for less than 5 days for perforated appendicitis. Regimens are of approximately equal efficacy, so consideration should be given to features such as medication allergy, pregnancy category (if applicable), toxicity, and cost.

• #9

  https://journals.lww.com/jtrauma/fulltext/2019/04000/methods_of_conservative_antibiotic_treatment_of.21.aspx

  Participants were prohibited oral intake 12 hours in two studies, 24 hours in nine studies, and 48 hours in one study, and allowed diet as tolerated in seven studies; diet was unspecified in 15 studies. […] Rates of initial clinical response during the index hospitalization were 88% or greater in 27 studies. […] In most studies, appendectomy was recommended for antibiotic-treated patients who initially had symptom resolution and experienced recurrence. […] This systematic review identifies patient populations most studied and common selection criteria and care methods, provides critical analysis in the context of applicable clinical guidelines and related research, and highlights areas of uncertainty so that patients can be best informed and managed should they consider this approach and researchers can better target unanswered questions about this care.

• #10 Appendicitis – Wikipedia

  https://en.wikipedia.org/wiki/Appendicitis

  The surgical procedure for the removal of the appendix is called an appendectomy. […] Appendectomy can be performed through open or laparoscopic surgery. Laparoscopic appendectomy has several advantages over open appendectomy as an intervention for acute appendicitis. […] Laparoscopic appendectomy was introduced in 1983 and has become an increasingly prevalent intervention for acute appendicitis. […] The treatment begins by keeping the person who will be having surgery from eating or drinking for a given period, usually overnight. An intravenous drip is used to hydrate the person who will be having surgery. Antibiotics given intravenously such as cefuroxime and metronidazole may be administered early to help kill bacteria and thus reduce the spread of infection in the abdomen and postoperative complications in the abdomen or wound. […] After surgery, the patient will be transferred to a postanesthesia care unit, so their vital signs can be closely monitored to detect anesthesia- or surgery-related complications. Pain medication may be administered if necessary.

• #11 Frequently Asked Questions About Appendicitis Treatment – Intercoastal Medical Group

  https://www.intercoastalmedical.com/2021/12/17/frequently-asked-questions-about-appendicitis-treatment/

  Appendectomy via open laparotomy or laparoscopy is the standard treatment for acute appendicitis. Jednakże, dożylne antybiotyki mogą być rozważane jako terapia pierwszego rzutu dla wybranych pacjentów. […] Natychmiastowa appendektomia jest uważana za złoty standard leczenia ostrego zapalenia wyrostka robaczkowego. […] Niektóre przypadki łagodnego zapalenia wyrostka robaczkowego poprawiają się tylko przy pomocy antybiotyków, ale lekarz będzie uważnie obserwował, aby określić, czy potrzebna jest operacja. […] Leki przeciwbólowe mogą być pomocne w tymczasowym łagodzeniu bólu. […] Jest nawet standardową praktyką natychmiastowe podawanie leków przeciwbólowych, takich jak opioidy, niesteroidowe leki przeciwzapalne (NLPZ) lub acetaminofen, po przyjęciu do szpitala, gdy pacjent jest diagnozowany z zapaleniem wyrostka robaczkowego.

• #12 Appendicitis — Non-operative Management of Acute Appendicitis — Clinical Pathway: Inpatient | Children’s Hospital of Philadelphia

  https://www.chop.edu/clinical-pathway/appendicitis-non-operative-management-acute-appendicitis

  Patients who will be managed initially with non-operative protocol will be admitted to General Surgery. […] Patients will remain NPO and receive IV antibiotics for at least 24 hours while VS and clinical exam are monitored. […] Patients who worsen or fail to improve will undergo appendectomy. […] Patients clinically improving, meeting Discharge Criteria Below […] Continue antibiotics for at least 24 hours […] Transition to PO antibiotics […] Discharge after tolerates 1st dose of antibiotics to complete 7 days of antibiotics. […] Criteria for Failure of Non-operative Management and Cross-over to Appendectomy Family decides they wish to pursue appendectomy. […] Patients Worsening or Inadequate Clinical Improvement within 12 – 24 Hours.

• #13 Appendicitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493193/

  Despite significant advancements in managing acute appendicitis with primary antibiotic therapy, the primary treatment option for acute appendicitis continues to be surgical. […] The efficacy of antibiotics as the primary treatment for acute uncomplicated appendicitis has been extensively researched, yielding mixed and contradictory results and conclusions. […] The Prospective Observational Study on Acute Appendicitis Worldwide (POSAW), an international collaborative study, has confirmed that surgical management remains the main effective option for treating appendicitis. […] Despite the availability of alternative therapeutic approaches with primary antibiotic therapy, appendectomy remains the standard practice for treating acute uncomplicated appendicitis. […] The gold-standard therapeutic intervention for acute appendicitis is appendectomy. Laparoscopic appendectomy is preferred over the open approach.

• #14 Acute Appendicitis: Efficient Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0701/p25.html

  Appendectomy via open laparotomy or laparoscopy is the standard treatment for acute appendicitis. […] However, intravenous antibiotics may be considered first-line therapy in selected patients. […] A meta-analysis of five randomized controlled trials found that antibiotic treatment for adults with appendicitis resulted in decreased complications, less sick leave or disability, and less need for pain medication compared with initial appendectomy. […] Emerging evidence suggests that antibiotic therapy may be considered a first-line and possibly sole therapy in selected patients with uncomplicated appendicitis. […] A meta-analysis of five randomized controlled trials compared various antibiotic treatments with appendectomy in 980 adults who had uncomplicated appendicitis. […] Antibiotic treatment resulted in a decreased rate of complications, less sick leave or disability, and less need for pain medication. […] Given the risks associated with open and laparoscopic appendectomies and the high resolution rate with intravenous antibiotics, antibiotic therapy should be considered an effective treatment option for adults and children.

• #15 Is it Appendicitis? Early Symptoms and More

  https://www.healthline.com/health/appendicitis

  Treatment typically involves antibiotics followed by surgery to remove your appendix. […] A doctor’s recommended treatment plan for appendicitis will most likely involve antibiotics followed by surgery to remove your appendix. This is known as an appendectomy. […] In rare cases, mild appendicitis may get better with antibiotics alone. But in most cases, you will need surgery to remove your appendix. […] During an appendectomy, a doctor will remove your appendix. If it has burst, they will also clean out your abdominal cavity. […] Like any surgery, an appendectomy carries some risks. However, the risks of an appendectomy are smaller than the risks of untreated appendicitis. […] To prevent or manage complications, a doctor may prescribe antibiotics, surgery, or other treatments. […] However, the risks associated with antibiotics and surgery are far less common and usually less serious than the potential complications of untreated appendicitis.

• #16 Treatment for Appendicitis – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis/treatment

  Doctors typically treat appendicitis by removing the appendix. This surgery is called an appendectomy. Surgeons perform the operation with general anesthesia in a hospital. Your doctor will recommend surgery if you have ongoing or long-lasting abdominal pain and fever, or if you show signs of a burst appendix and infection. Prompt surgery decreases the chances that your appendix will burst and cause additional health complications. […] Laparoscopic surgery is becoming increasingly common. It generally leads to fewer complications, such as hospital-related infections, and it has a shorter recovery time. After examining your condition and past medical history, your surgeon will recommend the best method for you. […] Some mild cases of appendicitis may be treated with antibiotics alone. Researchers are studying who might safely avoid surgery based on their symptoms, test results, health, and age, but surgery remains the standard of care.

• #17 Appendectomy | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/appendectomy

  Appendectomy is usually carried out on an emergency basis to treat appendicitis (inflamed appendix). […] Surgery is the preferred treatment for appendicitis. Delaying the operation (in the hope that the appendix will 'settle down’) only increases the risk of suffering a ruptured appendix. […] The two main surgical techniques include open and laparoscopic appendectomy. […] The type of operation you have will depend on how severe your appendicitis is. […] A laparoscopic appendectomy may need to become open surgery if the appendix has ruptured. […] If your appendix ruptures and you develop peritonitis, you will have antibiotics prescribed. […] All surgery carries some degree of risk. One of the most common complications following appendectomy is infection. […] The appendix appears to be a redundant organ, since the human body manages quite well without it. There is no chance of ever experiencing appendicitis again, because the appendix is entirely removed.

• #18 Appendicitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/appendicitis/diagnosis-treatment/drc-20369549

  Appendicitis treatment usually involves surgery to remove the appendix. Before surgery, antibiotics to treat infection may be given. […] Appendectomy is a surgery to remove the appendix. Appendectomy can be performed as open surgery using one abdominal cut about 2 to 4 inches long. This is called laparotomy. The surgery also can be done through a few small abdominal cuts. This is called laparoscopic surgery. During a laparoscopic appendectomy, the surgeon places special tools and a video camera into your abdomen to remove your appendix. […] In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for older adults and people with obesity. […] But laparoscopic surgery isn’t right for everyone. You may need an open appendectomy if your appendix has ruptured and infection has spread beyond the appendix, or you have an abscess. An open appendectomy allows your surgeon to clean the abdominal cavity.

• #19 Appendicitis: Early Symptoms, Causes, Treatment, Surgery

  https://www.medicinenet.com/appendicitis/article.htm

  To remove the appendix, the surgeon separates it from the mesentery, which is the tissue that delivers blood to the area. […] During an appendectomy, an incision two to three inches in length is made through the skin and the layers of the abdominal wall over the area of the appendix. […] New techniques for removing the appendix involve the use of the laparoscope. The laparoscope is a thin telescope attached to a video camera that allows the surgeon to inspect the inside of the abdomen through a small puncture wound (instead of a larger incision). If appendicitis is found, the appendix can be removed with special instruments that can be passed into the abdomen, just like the laparoscope, through small puncture wounds. […] The benefits of the laparoscopic technique include less post-operative pain (since much of the post-surgery pain comes from incisions) and a speedier return to normal activities.

• #20 Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3

  Current evidence shows laparoscopic appendectomy (LA) to be the most effective surgical treatment, being associated with a lower incidence of wound infection and post-intervention morbidity, shorter hospital stay, and better quality of life scores when compared to open appendectomy (OA). […] Over the past 20 years, there has been renewed interest in the non-operative management of uncomplicated AA, probably due to a more reliable analysis of postoperative complications and costs of surgical interventions, which are mostly related to the continuously increasing use of minimally invasive techniques. […] The most common postoperative complications, such as wound infection, intra-abdominal abscess, and ileus, vary in frequency between OA (overall complication rate of 11.1%) and LA (8.7%). […] The antibiotic-first strategy can be considered safe and effective in selected patients with uncomplicated acute appendicitis.

• #21 Appendicitis Treatment & Surgery | ACE Specialist Clinic

  https://acesurgery.sg/24-7-emergency/acute-appendicitis/

  Laparoscopic appendectomy is a minimally invasive surgery (MIS) that is the standard treatment for acute appendicitis. […] Appendectomy, the surgical removal of the inflamed appendix, is the most common and definitive treatment for acute appendicitis. It can be done by traditional open surgery or laparoscopic/minimally invasive surgery (MIS). […] Open appendectomy is a procedure where an incision is made in the lower right side of the abdomen to remove the inflamed appendix. […] Laparoscopic appendectomy is a minimally invasive procedure where tiny incisions are made, and a laparoscope (a thin tube with a camera) as well as specialised instruments, are used for the surgery. […] Patients typically experience faster recovery times, less postoperative pain, and reduced scarring than open surgery.

• #22

  https://www.laparoscopyhospital.com/forum/forum.php?p=&cat_id=&tid=3598

  Acute appendicitis is typically treated with surgery, specifically an appendectomy, which involves removing the inflamed appendix. This is considered the standard and most effective treatment. If left untreated, appendicitis can lead to serious complications, such as a ruptured appendix, which can be life-threatening. Non-surgical alternatives are generally not recommended for treating acute appendicitis because the condition can progress rapidly, and surgery is the most reliable way to address it. […] Acute appendicitis typically requires surgical intervention to prevent complications. Here are the risks and benefits of the two main surgical options: laparoscopic appendectomy and open appendectomy. Laparoscopic Appendectomy Benefits: Less Invasive: Smaller incisions, leading to less pain and scarring. Faster Recovery: Shorter hospital stay and quicker return to normal activities. Reduced Infection Risk: Lower risk of wound infections. Better Visualization: The laparoscopic camera provides a better view of the abdominal cavity, which can help in diagnosing other conditions if present. Risks: Complications from Anesthesia: As with any surgery requiring general anesthesia, there is a risk of adverse reactions. Intraoperative Complications: Risk of injury to surrounding organs and structures, though this is relatively rare. Conversion to Open Surgery: In some cases, the surgeon may need to switch to an open appendectomy if complications arise during the procedure. Open Appendectomy Benefits: Proven Technique: Long history of successful outcomes. Direct Access: Provides direct access to the appendix, which can be beneficial in complicated cases (e.g., ruptured appendix). Simplicity: Typically shorter operating time compared to laparoscopic surgery in some cases. Risks: Larger Incision: Larger incision leading to more pain, longer recovery, and a higher risk of infection. Longer Hospital Stay: Generally involves a longer hospital stay compared to laparoscopic surgery. Higher Risk of Complications: Higher risk of wound infections and hernias at the incision site. Decision Making The choice between laparoscopic and open appendectomy depends on several factors: Patient’s Condition: If the appendix has ruptured or there are complications, an open appendectomy might be preferred. Surgeon’s Expertise: Surgeons may prefer one technique over the other based on their experience and the specific situation. Patient’s Medical History: Previous abdominal surgeries or existing health conditions might influence the decision. Summary Laparoscopic Appendectomy: Generally preferred due to faster recovery, less pain, and lower infection risk, but with some risks associated with anesthesia and the need for potential conversion to open surgery. Open Appendectomy: Useful in complicated cases, with a longer recovery period and higher risk of wound-related complications, but with direct access to the appendix and a long history of successful use.

• #23 Appendicitis: Early symptoms, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/312123

• #24 Appendicitis Treatment Video | Appendicitis Causes & Symptoms | Appendix Surgery

  https://www.ypo.education/gastrointestinal/appendicitis-t150/video/

  Surgery is the standard treatment for appendicitis. Antibiotics are often given before surgery. […] Your doctor will perform the surgery under general anesthesia. The surgical technique for removal of the inflamed appendix will depend on you and your surgeon’s preference and whether the appendix has ruptured. […] The surgical techniques include: Laparoscopic appendectomy: Your surgeon will make small incisions in the abdomen and insert a laparoscope and other tiny instruments through them. […] Laparoscopic surgery will allow you to recover faster with fewer scars. However, if the appendix has ruptured and infection has spread, you may have to undergo open appendectomy which will allow your surgeon to thoroughly cleanse the abdominal cavity of any infectious material. […] Open appendectomy: Your surgeon will perform an open surgery through an incision of 2 to 4 inches on the abdomen and remove the appendix. If a rupture has occurred, the peritoneal cavity will be thoroughly irrigated to remove any pus. […] Appendicitis is a condition where the appendix becomes inflamed and infected requiring immediate surgical removal. You should consult your doctor if you experience symptoms of appendicitis in order to prevent life-threatening conditions caused due to a ruptured appendix.

• #25 Appendicitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493193/

  Many patients with a presumptive diagnosis of acute appendicitis can be managed with a laparoscopic approach uneventfully. […] Patients with a known periappendiceal abscess from a perforated appendix may require a percutaneous drainage procedure, usually performed by an interventional radiologist. […] While laparoscopic appendectomy has been widely used as the preferred approach for surgical management of acute appendicitis in many centers, open appendectomy might still be the practical choice in some clinical scenarios, such as complicated appendicitis with phlegmon. […] The preferred surgical management of appendiceal mucoceles is an appendectomy with great cautionary measures to prevent capsular rupture.

• #26 Appendicitis: Early symptoms, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/312123

• #27 Appendicitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/appendicitis/diagnosis-treatment/drc-20369549

  Expect to spend 1 to 2 days in the hospital after your appendectomy. […] If your appendix has burst and an abscess has formed around it, the abscess may be drained. To drain it, a tube is placed through your skin into the abscess. Appendectomy can be performed several weeks later, after the infection is under control. […] If your appendicitis isn’t serious and doesn’t require surgery, antibiotics may be used alone. However, if the appendix isn’t removed, there is a higher chance of appendicitis coming back.

• #28 Appendicitis | Signs, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/a/appendicitis

  Sometimes, when the appendix was burst for a long period of time, the appendectomy is done later. When this happens, your child will get IV antibiotics for a few days. You will then go home and come back to the hospital in six to eight weeks to have the appendix removed. This is known as an interval appendectomy. […] If the appendix did not rupture, most patients go home between two and 24 hours after surgery. […] If the appendix was ruptured, the hospital stay is usually between three to seven days. […] If the appendix was ruptured, your child will get IV antibiotics until their white blood cell count comes down or until they go home. […] For a ruptured appendix, your child may be able to go home when the following goals are met: Their belly wakes up. […] They no longer feel sick to their stomach.

• #29 Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3

  We recommend discussing NOM with antibiotics as a safe alternative to surgery in selected patients with uncomplicated acute appendicitis and absence of appendicolith, advising of the possibility of failure and misdiagnosing complicated appendicitis. […] In patients with complicated acute appendicitis, postoperative broad-spectrum antibiotics are suggested, especially if complete source control has not been achieved. […] We recommend against prolonging antibiotics longer than 35 days postoperatively in case of complicated appendicitis with adequate source control.

• #30 Appendicitis – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/appendicitis

  Treatment of acute appendicitis is open or laparoscopic appendectomy. Because treatment delay increases mortality, a negative appendectomy rate of 15% is considered acceptable. […] Appendectomy should be preceded by IV antibiotics. Third-generation cephalosporins are preferred. For nonperforated appendicitis, no further antibiotics are required. If the appendix is perforated, antibiotics should be continued for 4 days. […] Although several studies of nonoperative management of appendicitis (ie, using antibiotics alone) have shown high rates of resolution during the initial hospitalization, a significant number of patients have a recurrence and require appendectomy during the following year. Thus, appendectomy is still recommended, particularly if an appendicolith is visible on CT. […] When a large inflammatory mass is found involving the appendix, terminal ileum, and cecum, resection of the entire mass and ileocolostomy are preferable. In late cases in which a pericolic abscess has already formed, the abscess is drained either by an ultrasound-guided percutaneous catheter or by open operation (with appendectomy to follow at a later date).

• #31 Appendicitis | Signs, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/a/appendicitis

  They can eat. […] They do not have a fever. […] Pain management after surgery: Most patients will have some pain for the first few days after surgery. […] If the appendix did not rupture, Acetaminophen (Tylenol) and Ibuprofen (Motrin or Advil) are enough to manage pain. […] If the appendix ruptured, Acetaminophen (Tylenol) and Ibuprofen (Motrin or Advil) or Toradol will be given around the clock for the first two days after surgery. […] Patients almost never go home with opioid medications at discharge. […] An infection of the incision (cut on the skin) happens in about three of 10 kids after surgery. […] Treatment may include antibiotics and / or drainage of the wound. […] An abscess, a local infection inside of belly that has not spread (i.e., a pus pocket), is more common when the appendix ruptured (burst) before surgery. […] You need to come back to the hospital if there is concern for an abscess.

• #32 Treatment for Appendicitis – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis/treatment

  Treating the complications of a burst appendix will depend on which complication develops: peritonitis or an abscess. […] Surgery to remove your appendix is generally safe. However, complications are possible. Complications after laparoscopic surgery or open laparotomy may include infection of the surgical site, an abscess that forms inside your abdomen, a fistula, or abnormal passage, that forms between your intestine or stomach and your skin, a small bowel obstruction, ileus, a condition in which your bowel does not work correctly, abdominal adhesions, or bands of scar-like tissue that form inside your abdomen. […] After surgery, you will likely recover completely from appendicitis and wont need to make changes to your diet, exercise, or lifestyle. Surgeons generally recommend you limit physical activity for the first 3 to 5 days after laparoscopic surgery and for the first 10 to 14 days after a laparotomy. Talk with your surgeon about your recovery plan.

• #33 Antibiotics, Not Surgery, for Uncomplicated Appendicitis Now Routine

  https://www.uspharmacist.com/article/antibiotics-not-surgery-for-uncomplicated-appendicitis-now-routine

  Antibiotics, Not Surgery, for Uncomplicated Appendicitis Now Routine […] A review article in JAMA points out that many recent studies have demonstrated that antibiotics work as well as surgery for most uncomplicated appendicitis cases. […] The consensus of evidence suggests that antibiotics can successfully treat up to 70% of appendicitis cases; however, surgery, usually done laparoscopically, remains the definitive option for otherwise healthy patients with a severely inflamed appendix or other factors that increase the risk of rupture, according to the authors. […] If the scans reveal no complications, the authors advise that most of the patients could receive antibiotics instead of undergoing an appendectomy. […] „We think it’s going to be 60% to 70% of patients who are good candidates for consideration of antibiotics,” Dr. Pappas stated.

• #34 Appendicitis Treatment Without Surgery: Pros and Cons

  https://www.verywellhealth.com/appendicitis-treatment-without-surgery-7094503

  Surgery is widely viewed as the standard course of treatment for appendicitis. For some people, it may not be the only way to solve the problem. Research shows that you may be able to treat appendicitis without surgery. […] Certain antibiotics may work as well as surgery. These drugs may be used to treat severe symptoms in order to postpone or avoid surgery. Antibiotics may help when the appendicitis is not complex or the appendix does not pose the threat of bursting (rupturing). […] Up to 70% of people with appendicitis choose treatment without surgery. Research indicates that antibiotics work as all as surgery and may be an option for people with an uncomplicated appendix infection. […] Surgery remains the first-line therapy for people with an appendix at risk of rupture due to inflammation or other complications, but people with uncomplicated appendicitis may be good candidates for the antibiotics option. This nonsurgical approach may also be valuable for people with severe symptoms whose age or other conditions may increase the risk of surgery.

• #35 Are Antibiotics the Answer to Treating Appendicitis? | ACS

  https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2024/april-2024-volume-109-issue-4/are-antibiotics-the-answer-to-treating-appendicitis/

  According to Dr. Gunnells, as long as the chance for the patient with uncomplicated appendicitis requiring an operation in the future is minimal, treatment with antibiotics may be a safe option. […] CODA, a large, randomized clinical trial of antibiotics for appendicitis, was conducted at 25 US medical centers. […] While managing uncomplicated appendicitis with antibiotics is a safe, cost-effective alternative with potentially fewer complications than surgical treatment, appendectomies have a higher efficacy rate.

• #36 CODA study examines appendicitis treatment options – University of Mississippi Medical Center

  https://umc.edu/news/News_Articles/2020/10/CODA-study-examines-appendicitis-treatment-options.html

  In a study published online Oct. 5 in the New England Journal of Medicine, researchers found that prescribing antibiotics may be a good treatment option for some patients. […] If a patient has a strong preference to avoid having surgery, it is reasonable to try to treat appendicitis with antibiotics first, if their condition allows, said Dr. Matthew Kutcher, assistant professor of surgery at the University of Mississippi Medical Center and one of the studys co-authors. […] The Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) Trial found that three in 10 people who tried antibiotics required surgery to remove their appendix in the next three months, showing that this approach is not one size fits all. […] In addition, patients who opted for antibiotics were more likely to have complications that required them to return to the hospital, but also missed less time at school or work compared to surgery patients.

• #37 Treating appendicitis with antibiotics instead of surgery may be good option for some, but not all, patients – VUMC News

  https://news.vumc.org/2020/10/05/treating-appendicitis-with-antibiotics-instead-of-surgery-may-be-good-option-for-some-but-not-all-patients/

  Antibiotics instead of surgery may be a good choice for some, but not all, patients with appendicitis, according to results from a study reported today in the New England Journal of Medicine. […] The study compared immediate surgery for appendicitis against an alternative approach that used antibiotics initially to treat it, then only moved to surgery if the antibiotics strategy wasn’t working. […] Surgical removal of the appendix, an appendectomy, has been the standard of care for treatment of appendicitis for more than 120 years, but treatment with antibiotics is often proposed as an alternative. […] It appears that an antibiotics-first approach can lead to some patients recovering from appendicitis without surgery, but that approach certainly doesn’t work for everyone. […] The results of this study can be important for individuals with appendicitis as they, with their physician, determine the best treatment option, the study shows.

• #38

  https://journals.lww.com/jtrauma/fulltext/2019/04000/methods_of_conservative_antibiotic_treatment_of.21.aspx

  This systematic review describes specific components of medical management that may affect outcomes including patient selection, imaging, antibiotics, pain and diet management, criteria for antibiotic nonresponse and appendectomy, disposition, and follow-up. […] Most antibiotic regimens were consistent with 2010 and 2017 Infectious Diseases Society of America (IDSA) and Surgical Infection Society (SIS) guidelines for treatment of mild-to-moderate community-acquired intra-abdominal infections. […] Total intravenous and oral antibiotic duration ranged from 4 to 15 days. […] The most common total antibiotic duration was 10 days, which was used in 12 trials (35%). […] Although worsening or persistent pain were criteria for antibiotic nonresponse leading to appendectomy, pain control regimens generally were not specified in published trials.

• #39

  https://journals.lww.com/jtrauma/fulltext/2019/04000/methods_of_conservative_antibiotic_treatment_of.21.aspx

  A 2016 guideline, the World Society of Emergency Surgery concluded that antibiotic therapy can be successful in selected patients with uncomplicated appendicitis who wish to avoid surgery (level of evidence 1; grade of recommendation, A). […] Since the mid-1990s, eight randomized controlled trials (RCTs) have investigated conservative antibiotic treatment in comparison with urgent appendectomy for acute uncomplicated appendicitis. […] In 2015, Salminen et al. reported by far the largest RCT, which involved 530 adults, and found fewer complications, 6% initial antibiotic nonresponse and 23% 1-year recurrence rates, and 12 fewer disability days compared with mostly open appendectomy. […] Meta-analyses that included this trial found conservative treatment associated with similar or fewer total complications as surgery and concluded that it can be offered to patients.

• #40 Appendicitis Treatment Without Surgery: Pros and Cons

  https://www.verywellhealth.com/appendicitis-treatment-without-surgery-7094503

  While there is no standardized regimen, the following antibiotics are used in treating appendicitis: Augmentin (amoxicillin/clavulanate), Zosyn (piperacillin/tazobactam), Ceftriaxone, Ciloxan (ciprofloxacin), Invanz (ertapenem), Principen (ampicillin), Flagyl (metronidazole). […] The benefits of nonsurgical appendicitis treatment include: Less risk: Treatment with antibiotics avoids the risk of morbidity (death) and complications that can occur with any type of anesthesia and surgery. It also avoids the risks of undergoing an appendectomy with a ruptured appendix, which can involve an intra-abdominal abscess or infection of the incision. […] Suitable for older people: Appendicitis treatment without surgery may be suitable for adult patients with a high risk of operative complications. Older people who undergo an appendectomy have a higher risk of intraoperative perforation and/or abscess and postoperative intra-abdominal abscess than younger people.

• #41 Most patients with appendicitis can have antibiotics as their first treatment, rather than appendectomy | ACS

  https://www.facs.org/media-center/press-releases/2021/coda-study-102521/

  Most patients with appendicitis can have antibiotics as their first treatment, rather than appendectomy. […] Study results show the safety and sustainability of another treatment option besides surgical removal of the appendix. […] Study findings highlight the need for increased shared decision making between surgeons and patients on the need for and timing of an appendectomy. […] About half of patients with appendicitis do not need an appendectomy procedure up to four years after receiving a course of antibiotics, according to final results of the Comparison of Outcomes of antibiotic Drugs and Appendectomy (CODA) trial. […] These results show the safety and sustainability of another treatment option besides surgical removal of the appendix. […] Based on their characteristics, circumstances, and priorities, antibiotics will be a good treatment for some, but probably not all patients with appendicitis.

• #42 Most patients with appendicitis can have antibiotics as their first treatment, rather than appendectomy | ACS

  https://www.facs.org/media-center/press-releases/2021/coda-study-102521/

  CODA is the largest randomized clinical trial to explore whether antibiotic treatment is as good as appendectomy in treating appendicitis. […] The College called antibiotics an acceptable first-line treatment for most patients with appendicitis. […] Among the study patients who initially received nonoperative treatment, the proportion who eventually underwent an appendectomy increased over time. […] Recurrent appendicitis was the primary reason for getting an appendectomy after antibiotic treatment, according to updated results. […] While some clinicians and patients may determine that these longer-term rates of appendectomy make antibiotics a less desirable treatment, a very high proportion of patients report a preference for antibiotics, even if appendectomy may ultimately be necessary.

• #43 Comparing Antibiotics versus Surgery for Treating Appendicitis — The CODA Study | PCORI

  https://www.pcori.org/research-results/2015/comparing-antibiotics-versus-surgery-treating-appendicitis-coda-study

  Patients and their doctors can use the results when considering how to treat appendicitis. […] This randomized noninferiority trial compared the effectiveness of an appendectomy versus antibiotics in treating appendicitis 30 days posttreatment. […] Researchers randomized patients to receive either an appendectomy or antibiotics. Patients who received antibiotics received them intravenously for one day and orally for nine more days. […] When measured 30 days posttreatment, health status was no worse for patients randomized to receive antibiotics than for those randomized to receive an appendectomy. […] At 90 days, 71% of patients treated with antibiotics had not had an appendectomy. Compared with patients who initially received an appendectomy, patients who received antibiotics: Were more likely to be hospitalized after initial treatment

• #44 Non-Surgical Appendicitis Treatment Gives Parents Options

  https://www.nationwidechildrens.org/family-resources-education/700childrens/2015/12/non-surgical-appendicitis-treatment-give-parents-options

  Typically, when most parents hear the word appendicitis, they also hear the word surgery. Appendectomies have been performed safely for decades and are a proven treatment for appendicitis. But what if there was another treatment option that didn’t require surgery? If your child qualified, what if their appendicitis could be treated with antibiotics alone? […] In our recent study, we found that children with uncomplicated appendicitis who elected to do so could be successfully sent home without surgery. They experienced less pain and no harmful side effects and did not later require an appendectomy by their one-year follow-up. […] Children who were treated with antibiotics also experienced nearly four fewer sick days at home on average than those who underwent surgery. Their caregivers required less of this time as well.

• #45 Appendicitis Treatment Without Surgery: Pros and Cons

  https://www.verywellhealth.com/appendicitis-treatment-without-surgery-7094503

  Longer follow-up: Appendicitis treatment without surgery can involve a longer follow-up period. A higher recurrence rate can require subsequent antibiotics or an appendectomy. […] You may be eligible for antibiotic therapy if your condition is not deemed complicated or at risk of perforation for other reasons. While effective, the rate of recurrence is higher than surgery. […] In a five-year follow-up of patients with uncomplicated acute appendicitis who were treated with antibiotics, researchers indicated that appendicitis recurred 27.3% at one year, 34% at two years, 35.2% at three years, 37.1% at four years, and 39.1% at five years. […] When chronic appendicitis does not advance to the need for emergency surgery, antibiotics may be used as a first-line treatment to resolve the problem without surgery. If the problem persists, an appendectomy is recommended. […] Your healthcare provider can advise you on which treatment may be better for you. You may have to choose whether you prefer surgery without the worry of repeat disease or drugs without the risk of surgery.

• #46 Appendicitis Treatment Without Surgery: Pros and Cons

  https://www.verywellhealth.com/appendicitis-treatment-without-surgery-7094503

  Avoid negative appendectomy: Leaving your appendix intact avoids the possibility of a negative appendectomy, which is the removal of a normal appendix. […] Recuperation is faster: People treated with antibiotics are more likely to miss fewer days of work and resume leisure activities sooner than those who pursue surgery, according to research comparing the results of surgery and antibiotics treatment. […] The drawbacks of appendicitis treatment without surgery include: Higher rate of recurrence: The surgical removal of your appendix prevents the possibility of recurrence. However, treatment with antibiotics does not involve a definitive outcome. Recurrence of appendicitis ranges from 0% to 40% after treatment with antibiotics, resulting in the need for additional treatment or an appendectomy at a later time.

• #47 Appendicitis Treatment Without Surgery: Pros and Cons

  https://www.verywellhealth.com/appendicitis-treatment-without-surgery-7094503

  Longer hospital stays: Studies indicate that people treated with antibiotics are more likely to spend more time in the hospital than those who have had an appendectomy. This is likely due to the treatment administered, which usually involves three to five days of intravenous (IV) therapy vs. the next-day discharge common with an appendectomy. […] Missed opportunity to discover other diseases: An appendectomy allows surgeons to discover conditions that mimic the symptoms of appendicitis. These issues can include cecal neoplasm (a tumor in the area connecting the small and large intestines) and malignancies like carcinoid tumors (slow-growing cancer that can develop in many places in the body), which can be missed with antibiotic treatment. […] The potential risk of antibiotic resistance: A review of related research indicates no standardized antibiotic regimen for treating appendicitis. There is an increased public health threat of antimicrobial resistance with the use of empirical broad-spectrum antibiotics over time can lead to the growth of resistant strains of bacteria.

• #48 Appendicitis Treatment: Appendectomy, Interval Appendectomy

  https://www.webmd.com/digestive-disorders/understanding-appendicitis-treatment

  Surgery to remove the appendix, which is called an appendectomy, is the standard treatment for appendicitis. […] If your doctor suspects appendicitis, they will likely quickly remove the appendix to avoid its rupture. If the appendix has formed an abscess, you may have two procedures, one to do a CT-guided drainage of the pus and fluid, and a second one to remove the appendix eight to 12 weeks later. This delayed surgery is called an interval appendectomy. […] Antibiotics are given before an appendectomy to fight possible peritonitis or infection of the abdominal cavity’s lining. General anesthesia is given, and the appendix is removed through a short incision in the right lower quadrant of the abdomen. If you have peritonitis, the abdomen is also drained of pus. Within 12 hours of surgery, you are likely to be up and moving around. You can usually return to normal activities in two or three weeks. If surgery is done with a laparoscope (a thin telescope-like instrument for viewing inside the abdomen), three to four smaller incisions are made. With this procedure, recovery is faster. […] After having your appendix removed, keep your incision clean to promote healing and avoid infection. Follow any instructions that your surgeon gave you.

• #49 Appendicitis: Early Symptoms, Causes, Treatment, Surgery

  https://www.medicinenet.com/appendicitis/article.htm

  On occasion, a person may not see their doctor until appendicitis with rupture has been present for many days or even weeks. In this situation, an abscess usually has formed, and the appendiceal perforation may have closed over. If the abscess is small, it initially can be treated with antibiotics; however, an abscess usually requires drainage. A drain (a small plastic or rubber tube) usually is inserted through the skin and into the abscess with the aid of an ultrasound or CT scan that can determine the exact location of the abscess. The drain allows the pus to flow from the abscess out of the body. The appendix may be removed several weeks or months after the abscess has resolved. This is called an interval appendectomy and is done to prevent a second attack of appendicitis. […] Can surgery fix appendicitis (appendectomy)?

• #50

  https://www2.hse.ie/conditions/appendicitis/treatment/

  One of the main advantages of keyhole surgery is the recovery time tends to be short. Most people can leave hospital a few days after the operation. If the appendix is operated upon promptly, most patients can go home within 24 hours of the operation. […] In most cases, you can return to normal activities in a couple of weeks. You may need to avoid strenuous activities for 4 to 6 weeks after open surgery. […] Appendectomies are one of the most commonly-performed operations in Ireland. Serious or long-term complications are rare. […] But, like all types of surgery, there are some risks. These include: wound infection. You might get antibiotics to minimise the risk of serious infections. […] The use of general anaesthetic also carries some risks. These include the risk of an allergic reaction. You could also inhale stomach contents. This could lead to pneumonia. But serious complications like this are very rare. […] In some cases, appendicitis can lead to the development of a lump on the appendix called an appendix mass. […] Instead, they’ll give you a course of antibiotics. You will get an appointment for an appendectomy a few weeks later, when the mass has settled.

• #51 Appendicitis

  https://www.nhs.uk/conditions/appendicitis/

  Appendicitis is usually treated with surgery to remove your appendix (an appendectomy). You do not need your appendix, so it’s not harmful to remove it. […] If you need surgery, it will be done as soon as possible, but you may need to wait a few hours. The operation usually takes about an hour. […] Sometimes it’s possible to treat appendicitis with antibiotics rather than surgery. This may be recommended if the infection has not spread and surgery is high risk for you. […] Sometimes appendicitis causes a lump where part of your abdomen and bowel stick to your appendix, called an appendix mass. If this happens you’ll usually need antibiotics first, and then surgery a few weeks later if you still have symptoms.

• #52 Appendicitis In Kids and Teens (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/appendicitis.html

  Appendicitis is a medical emergency. It’s important to know what to look for and, if your child has any signs, get care right away. […] For most kids, a surgeon will operate to take out the infected appendix. This is called an appendectomy. Usually, surgeons make 3 small cuts in the belly and use a small device called a laparoscope to remove the appendix. Kids who get this surgery might go home the same day, though some might stay longer. […] Sometimes, doctors can treat kids with early cases or very mild appendicitis using only antibiotics instead of antibiotics and surgery. With this newer way to treat appendicitis called non-operative treatment kids avoid surgery and get back to regular activities sooner. […] If your child has appendicitis, the care team will talk to you about treatment options and their benefits, risks, and possible side effects (for example, antibiotics could cause diarrhea or interfere with other medicines, like oral contraceptives).

• #53 Appendicitis management: Is it time for a change? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/6/309

  Recent studies of appendicitis management in pediatric patients show that pediatric patients with appendicitis can be treated safely with antibiotics alone, but that nonoperative management will fail within 1 year in up to one-third of patients. The presence of appendicolith is associated with increased risk of failure of nonoperative management.

• #54 Most patients with appendicitis can have antibiotics as their first treatment, rather than appendectomy | ACS

  https://www.facs.org/media-center/press-releases/2021/coda-study-102521/

  Especially in the emergency setting, patients may prefer to avoid or delay an operation for reasons including current demands at work and home, lack of health insurance, or anxiety. […] Complications were uncommon in both treatment groups after the first month, researchers reported. […] To help patients make treatment decisions regarding their appendicitis, CODA investigators developed an online decision-making tool. […] The online tool will be part of a national implementation program, led partly by the ACS, which will include training clinicians and developing a protocol to standardize appendicitis treatment. […] Picking the best candidate for either therapy comes down to having a discussion with each patient about their goals and values for treatment of their appendicitis and discussing the risks and benefits of each treatment with those goals and values in mind.

• #55

  https://www1.racgp.org.au/newsgp/clinical/antibiotics-a-viable-treatment-for-appendicitis-st

  While this research added further evidence to the use of antibiotics, co-investigator Dr Jeffrey Johnson says it also shows there is no one-size-fits-all approach in treating appendicitis. […] Patients ought to evaluate the benefits and risks of taking antibiotics or opting for surgery and make an informed decision on what is important to them. […] The important thing that comes out of these studies is that they give us more information to be able to have detailed discussions with patients about their treatment options and potential risks.

• #56 Treatment of Acute Appendicitis | IntechOpen

  https://www.intechopen.com/online-first/1206766

  Treatment of appendicitis is continuously evolving. Appendectomy remains the standard for acute cases, whereas antibiotics are increasingly explored for uncomplicated appendicitis, showing comparable short-term outcomes. […] Conservative antibiotic therapy, targeting aerobic and anaerobic bacteria, is viable for selected cases, particularly those without complicating factors. Complicated appendicitis warrants emergency appendectomy, laparoscopic or open. […] Debates persist over missed malignancies and long-term efficacy with conservative management, despite benefits like reduced pain and quicker recovery compared to surgery. […] Surgical removal remains dominant due to historically higher success rates and concerns over missing neoplasms. Nonetheless, antibiotics present a safe alternative for carefully selected patients.

• #57 Appendectomy (Appendix Removal): Surgery & Recovery

  https://my.clevelandclinic.org/health/procedures/21922-appendectomy

  Appendectomy is surgery to remove an inflamed or infected appendix. Its still the definitive treatment for appendicitis. […] In most cases, appendectomy is the safest treatment for appendicitis in children and adults. […] Appendix removal has been the standard treatment for appendicitis for over 100 years. […] Appendectomy is the definitive treatment for appendicitis, with a success rate of over 95%. […] Appendectomy is still the safest, most effective way to treat appendicitis and prevent the spread of infection which can be catastrophic.

• #58 Antibiotics, Not Surgery, for Uncomplicated Appendicitis Now Routine

  https://www.uspharmacist.com/article/antibiotics-not-surgery-for-uncomplicated-appendicitis-now-routine

  In patients without high-risk CT findings, either appendectomy or antibiotics can be considered as first-line therapy. […] Antibiotics are not always a complete cure, however. In about 40% of cases, patients who recover from appendicitis after receiving antibiotics experience another episode and eventually need surgery. […] „It’s important to take into account every case and its unique context as we consider patient preferences,” Dr. Pappas stated.

• #59 CODA study examines appendicitis treatment options – University of Mississippi Medical Center

  https://umc.edu/news/News_Articles/2020/10/CODA-study-examines-appendicitis-treatment-options.html

  Kutcher said that neither approach is one-size fits all. For instance, people with heart or lung conditions that increase the risks associated with anesthesia may benefit from using a course of antibiotics instead of surgery. […] With the antibiotics approach, a patient could be treated for appendicitis without having to stay overnight in the hospital, Kutcher said, receiving an intravenous course in a clinic setting, then taking a course of oral antibiotics at home while resuming regular activities. […] The most important aspect of the CODA, he said, is the patients involvement in decision-making. […] We have two very good treatments for appendicitis, Kutcher said. Physicians should present these options, their benefits and risks, and participate in shared decision-making process with their patients.

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