Initial Abx Feasible Alternative for Uncomplicated Appendicitis
TUESDAY, Sept. 25, 2018 -- The cumulative incidence of appendicitis recurrence within five years is 39.1 percent among patients with uncomplicated acute appendicitis initially treated with antibiotics, according to research published in the Sept. 25 issue of the Journal of the American Medical Association.
Paulina Salminen, M.D., Ph.D., from Turku University Hospital in Finland, and colleagues conducted a five-year observational follow-up of patients in the Appendicitis Acuta (APPAC) randomized clinical trial comparing appendectomy with antibiotic therapy. Five hundred thirty patients aged 18 to 60 years were randomized to undergo an appendectomy (273 patients) or receive antibiotic therapy (257 patients).
The researchers found that 70 patients who initially received antibiotics underwent appendectomy in the first year (27.3 percent), and 30 additional antibiotic-treated patients underwent appendectomy between years one and five (16.1 percent). At two, three, four, and five years, the cumulative incidence of appendicitis recurrence was 34.0, 35.2, 37.1, and 39.1 percent, respectively. The overall complication rate at five years was 24.4 and 6.5 percent in the appendectomy and antibiotic groups. The groups did not differ in terms of length of hospital stay; however, there was a significant difference in sick leave (11 days more in the appendectomy group).
"This long-term follow-up supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis," the authors write.
One author disclosed financial ties to the pharmaceutical industry.
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Posted: September 2018