Antibiotics Instead of Surgery for Appendicitis?

A recurrence occurred (and was treated surgically) in 27% of the antibiotic group in this randomized trial.

Prior studies of antibiotics instead of surgery for appendicitis have yielded conflicting results (NEJM JW Emerg Med Jun 2014 and Ann Surg 2014 [e-pub]; NEJM JW Emerg Med Jul 2014 and J Am Coll Surg 2014; 218:905 and J Am Coll Surg 2014 [e-pub]; NEJM JW Emerg Med Jul 2011 and Lancet 2011; 377:1573). In a multicenter Finnish trial, investigators randomized 530 patients (aged 18–60 years) with uncomplicated acute appendicitis confirmed by computed tomography (CT) to surgery or antibiotic treatment. The antibiotic group received intravenous ertapenem (1 g per day) for 3 days followed by oral levofloxacin (500 mg once per day) plus metronidazole (500 mg 3 times per day) for 1 week. Patients were followed for 1 year.

Successful appendectomy, the …

Reviewing Author

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Antibiotics Instead of Surgery for Appendicitis?

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Reviewing Author