APPAC
Is antibiotic therapy noninferior to appendectomy in patients with uncomplicated acute appendicitis?
Study design
Population
- 530 patients (201 female, 329 male)
- Inclusion criteria: patients with uncomplicated appendicitis confirmed by a CT scan
- Key exclusion criteria: complicated appendicitis, age < 18 years or > 60 years, contraindications for CT (eg, pregnancy or lactating, allergy to contrast media or iodine, renal insufficiency with serum creatinine level >
150 Mmol/L, actively taking metformin), peritonitis, unable to cooperate and provide informed consent, and the presence of serious systemic illness
Interventions
- N=257 antibiotic treatment (ertapenem 1 g IV once daily for 3 days followed by 7 days of levofloxacin 500 mg PO once daily and metronidazole 500 mg 3 times per day)
- N=273 surgical appendectomy (standard open appendectomy)
Primary outcome
Safety outcomes
Significant differences in overall complication rate (2.8% vs. 20.5%, p < 0.001; difference, 17.7%, 95% Cl 11.9% to 23.4%).
Conclusion
In patients with uncomplicated appendicitis confirmed by a CT scan, antibiotic treatment was not noninferior to surgical appendectomy with respect to treatment success.