Could Antibiotics Be an Effective Alternative to Appendectomy?
Antibiotics may be a reasonable alternative to appendectomy in patients with acute uncomplicated appendicitis, according to recent research.
In order to compare the efficacy of both treatment options, researchers conducted a noninferiority randomized clinical trial involving 530 patients with uncomplicated acute appendicitis confirmed by computed tomography scan.
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Participants were randomized to either intravenous ertapenem (1 g/d) for 3 days, then 7 days of oral levofloxacin (500 mg) and metronidazole (500 mg 3 times a day), or standard open appendectomy.
All but 1 of the 273 patients in the surgical group underwent successful appendectomy (success rate of 99.6%).
Of the 257 participants in the antibiotic group, 70 underwent appendectomy within 1 year due to appendicitis recurrence (success rate of 72.7%).
Due to the noninferiority margin of 24%, researchers were unable to declare antibiotics noninferior to appendectomy.
“Among patients with CT-proven, uncomplicated appendicitis, antibiotic treatment did not meet the prespecified criterion for noninferiority compared with appendectomy,” they concluded.
“Most patients randomized to antibiotic treatment for uncomplicated appendicitis did not require appendectomy during the 1-year follow-up period, and those who required appendectomy did not experience significant complications.“
—Michael Potts
Reference:
Salminen P, Paajanen H, Rautio T, et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitisthe appac randomized clinical trial. JAMA. 2015;313(23):2340-2348.