Recurrent Appendicitis Rate May Be Reduced by Antibiotics
Adults treated with antibiotics alone for uncomplicated acute appendicitis have a 39.1%
likelihood of late recurrence at 5 years, according to results of a long-term observational study.
Antibiotics are an effective alternative to surgery for treating uncomplicated acute appendicitis in the short-term. However, long-term outcomes are unknown.
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In the Appendicitis Acuta (APPAC) study—conducted from November 2009 to June 2012—researchers randomly assigned 530 patients to undergo appendectomy (n = 273) or receive antibiotic therapy consisting of intravenous ertapenem for 3 days followed by 7 days of oral levofloxacin and metronidazole (n = 257).
Secondary endpoints reported at 5 years included late appendicitis recurrence—defined as 1 year or later—after antibiotic treatment, complications, length of hospital stay, and sick leave.
Results showed that 70 patients who had received antibiotics at baseline underwent appendectomy within 1 year; 30 additional patients who had received antibiotics at baseline underwent appendectomy between 1 and 5 years.
Of the patients who had received antibiotics at baseline, the cumulative incidence of appendicitis recurrence was 34.0% at 2 years, 35.2% at 3 years, 37.1% at 4 years, and 39.1% at 5 years.
The overall complication rate at 5 years was 24.4% for patients who had underwent appendectomy, compared with 6.5% for patients who had received antibiotics.
No difference in length of hospital stay was observed between the groups. However, patients who had underwent appendectomy accrued 11 more days of sick leave than patients who had received antibiotics.
“This long-term follow-up supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis,” the researchers concluded.
—Melinda Stevens
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 [Published online September 25, 2018]. JAMA. https://doi.org/10.1001/jama.2018.13201.