Antibiotic treatment alone may be appropriate in patients with uncomplicated acute appendicitis, according to the findings of a long-term study.
The study was a five-year observational follow-up of 530 uncomplicated acute appendicitis patients aged 18-60 years old either underwent an appendectomy (n = 273) or received antibiotic therapy (n = 257). The initial trial took place from November 2009 to June 2012 in Finland, and the five-year follow-up of the antibiotic cohort was conducted on Sept. 6, 2017.
It is complicated but remember when surgery for appendicitis was a "parachute intervention"?
Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis https://t.co/86tNJ6x5wV— Adam Cifu (@adamcifu) September 27, 2018
The group treated antibiotically received ertapenem intravenously for three days followed by seven days of levofloxacin and metronidazole orally.
Of the 257 antibiotic patients, 70 underwent an appendectomy within the first year (27.3% [95% CI, 22.0%-33.2%]; 70/256), and an additional 30 additional (16.1% [95% CI, 11.2%-22.2%]; 30/186) did so between one and five years. The appendicitis recurrence rate was 34.0% (95% CI, 28.2%-40.1%; 87/256) at two years, 35.2% (95% CI, 29.3%-41.4%; 90/256) at three years, 37.1% (95% CI, 31.2%-43.3%; 95/256) at four years, and 39.1% (95% CI, 33.1%-45.3%; 100/256) at five years. Eighty-five patients in the antibiotic group had surgery for recurrent appendicitis, of which 76 had uncomplicated appendicitis, two had complicated appendicitis, and seven did not have appendicitis. The operative group had a higher complication rate (24.4%; 95% CI, 19.2%-30.3%) (n = 60/246) than the antibiotic group (6.5%; 95% CI, 3.8%-10.4%) (n = 16/246). Hospital length of stay between the groups was the same, but the appendectomy group had 11 more days in sick leave than the antibiotic group.
According to new research, 70-80% of patients with acute appendicitis may only need treatment with antibiotics instead of surgery. https://t.co/hAOHPgjvxm pic.twitter.com/UG5zBbYxnI
— WebMD (@WebMD) September 25, 2018
In an accompanying editorial, Dr. Edward Livingston said that even in patients who ultimately have surgery, it still makes sense to try antibiotics first.
“Although patients may be concerned about the ultimate need for surgery from a health outcomes perspective, nonsurgical treatment in uncomplicated appendicitis before proceeding to surgery is a reasonable option,” Livingston wrote. “Given that access to a surgeon is not always available, these results may have implications in many different settings and in many different countries.”
Five-year follow-up confirms safety of antibiotics for uncomplicated appendicitis: https://t.co/S97tSe8pja #ptsafety
— American College of Surgeons (@AmCollSurgeons) September 26, 2018
Additional research may help determine earlier on which patients are at risk for recurrent appendicitis, Livingston said.
The study authors concluded, “This long-term follow-up supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis.”
Diagnostic accuracy of laboratory and ultrasound findings in patients with a non-visualized appendix
The immunological functions of the Appendix: An example of redundancy?
Source: JAMA
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