Study examines feasibility of using antibiotics to manage appendicitis

Patients with uncomplicated acute appendicitis treated with antibiotics can recover without surgery, according to a recent study. In the image, low magnification micrograph of acute appendicitis and periappendicitis — Patients with uncomplicated acute appendicitis (pictured as micrograph) treated with antibiotics can recover without surgery

There is growing interest in using antibiotics to manage acute appendicitis. However, a large randomised controlled trial published in JAMA
^[1] (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.