The CODA Trial

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Drs. David Talan and Mel Herbert discuss the CODA Trial, a randomized trial comparing antibiotics with appendectomy for appendicitis.

Link to article:
https://www.nejm.org/doi/full/10.1056/NEJMoa2014320

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Maxim BY, MDCM, FRCP-EM/PEM -

great discussion from Dr. Talan! are you expecting that cumulative incidence curve to remain flat past 90 days?

Which antibiotics are you recommending? Always 1st dose IV and then PO; or can we go straight to PO or IM and then PO?

Mel H. -

As far as antibiotics, we gave a long-acting IV regimen since some patients have a lot of nausea initially, appendicitis being an intra-abdominal process. So ceftriaxone and the daily metronidazole dose of 1500 mg IV for adults; some use ertapenem. Then po cefdinir or a quinolone and flagyl to complete 10 days.

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