Antibiotics Alone Seem Reasonable for Uncomplicated Appendicitis in Adults

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

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."