Antibiotics Are Not Equal to Appendectomy for Appendicitis

Four recent randomized trials suggest that antibiotics alone can cure uncomplicated appendicitis or be used as first-line treatment. In this noninferiority trial, 239 adults with computed tomography–confirmed acute uncomplicated appendicitis at six academic hospitals in France were randomized to receive amoxicillin plus clavulanic acid (3 g daily for 8 to 15 days) or emergent appendectomy.

Incidence of peritonitis at 30 days, the primary endpoint, was significantly higher in the antibiotic group than the surgery group (8% vs. 2%). Overall, 68% of antibiotic-treated patients did not require appendectomy during 1 year of follow-up.