Antibiotic therapy alone appears to be feasible for the initial treatment of uncomplicated appendicitis in adults, according to longer-term follow-up from the APPAC trial, published in JAMA.
Roughly 530 adults with uncomplicated acute appendicitis confirmed on computed tomography were randomized to appendectomy or antibiotics. The latter entailed intravenous ertapenem for 3 days, followed by oral levofloxacin and metronidazole for 7 days.
By 5 years, appendicitis had recurred in 39% of patients in the antibiotic group: 70% of these patients underwent appendectomy in the year after randomization, and 30% did so between years 1 and 5. The overall complication rate was significantly higher with initial appendectomy than with antibiotics (24% vs. 7%). There were no complications related to delayed appendectomy.
An editorialist writes, “The findings … dispel the notion that uncomplicated acute appendicitis is a surgical emergency. Although patients may be concerned about the ultimate need for surgery from a health outcomes perspective, nonsurgical treatment … before proceeding to surgery is a reasonable option.”