There is growing interest in using antibiotics to manage acute appendicitis. However, a large randomised controlled trial published in JAMA
(online, 16 June 2015) failed to meet the required endpoint in enough patients to support the idea.
The Appendicitis Acuta trial enrolled 530 patients with uncomplicated acute appendicitis confirmed by a CT scan. Patients randomised to antibiotics (n=257) received intravenous ertapenem for three days followed by seven days of oral levofloxacin and metronidazole, whereas patients randomised to surgery underwent standard open appendectomy.
Most antibiotic-treated patients recovered without surgery but 70 underwent appendectomy within one year of initial presentation for appendicitis. Analysis yielded a difference in treatment efficacy between groups of âˆ’27.0%, which did not meet the prespecified noninferiority margin for the study. The results should help patients make an informed decision, say the researchers.
 Salminen P, Paajanen H, Rautio T et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: The APPAC randomized clinical trial. JAMA 2015;313(23):2340–2348. doi:10.1001/jama.2015.6154.