Uncomplicated Appendicitis: Is Antibiotic Therapy Enough?

Antibiotic therapy alone is a feasible alternative to surgery in adults with uncomplicated acute appendicitis, according to the results of a recent study.

While short-term results have shown that antibiotics could be an alternative to surgery in patients with uncomplicated appendicitis, long-term outcomes are not currently known.

To further explore this, researchers conducted a 5-year observational follow-up of participants in the Appendicitis Acuta (APPAC) multicenter randomized clinical trial. In the study, 530 patients aged 18 to 60 years were randomly assigned to either appendectomy (n = 273) or antibiotics (n = 257).

Overall, 70 patients who initially received antibiotics underwent appendectomy within the first year (27.3%) and 30 who received antibiotics underwent appendectomy between years 1 and 5 (16.1%). The cumulative incidence of appendicitis recurrence was 34% at 2 years, 25.2% at 3 years, 27.1% at 4 years, and 39.1% at 5 years. At 5 years, the overall complication rate was 24.4% in the appendectomy group and 6.5% in antibiotic group.

“Among patients who were initially treated with antibiotics for uncomplicated acute appendicitis, the likelihood of late recurrence within 5 years was 39.1%. This long-term follow-up supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis.”

—Michael Potts

Reference:

Salminen P, Tuominen R, Paajanen H, et al.

Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC randomized clinical trial. JAMA. 2018;320(12):1259-1265.