Acute Appendicitis —What’s Old Is New Again

The Appendicitis Acuta II (APPAC II) trial was a rigorous noninferiority randomized clinical trial that compared the effectiveness of oral antibiotics alone vs a combination of intravenous and oral antibiotics for the initial management of uncomplicated acute appendicitis. Planned 3-year follow-up data were presented in the secondary analysis by Sel änne et al in this issue of JAMA Surgery. Although we cannot ascertain a pharmacological or pathophysiological reason that the route of initial treatment would affect risk of recurrence 2 to 3 years after resolution of the index episode, these longer-term data do contribute to the body of evidence that antibiotic treatment has lasting effectiveness. Consistent with results from the original APPAC trial and its North American counterpart the Comparison of the Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial, this 3-year follow-up of the APPAC II trial found that appendicitis recurren ce tends to be early and adverse sequelae remain unlikely. At year 3, 63.4% of patients in the oral antibiotics monotherapy group and 65.2% of patients in the combined IV and oral antibiotics group had not undergone appendectomy, and most recurrences occurred in the first year. Similarly, among pati ents randomized to antibiotics in the CODA trial, 60% and 56% had not undergone appendectomy at the year 1 and year 2 follow-up, respectively. Half of those year 1 appendectomies occurred in the first 30 days, with a significantly higher risk if ...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research