Antibiotic therapy alone appears to be a feasible alternative to surgery for treating uncomplicated acute appendicitis, according to results from a 5-year observational follow-up study published in JAMA.

The study included 530 patients, aged 18 to 60 years, with computed tomography-confirmed uncomplicated acute appendicitis. These patients were randomized to either undergo appendectomy (N=273) or receive antibiotic treatment (N=257) consisting of ertapenem IV for 3 days followed by 7 days of oral levofloxacin and metronidazole. The primary outcome measures of the study were appendicitis recurrence after antibiotics, complications, length of hospital stay and sick leave at the 5-year follow-up.

Within the first year, 70 patients who initially received antibiotics underwent appendectomy; an additional 30 antibiotic-treated patients underwent appendectomy within the 5-year timeframe of the study. Results showed that for those treated with antibiotics the cumulative incidence of appendicitis recurrence at 1, 2, 3, 4, and 5 years was 27.3%, 34.0%, 35.2%, 37.1%, and 39.1%, respectively.

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The overall complication rate (surgical site infections, incisional hernias, abdominal pain, obstructive symptoms) at 5 years was found to be 24.4% (95% CI, 19.2%-30.3%) in the appendectomy group (N=60/246) vs 6.5% (95% CI, 3.8%-10.4%) in the antibiotic group (N=16/246) (P<.001). While there was no significant difference in length of hospital stay between the groups, patients in the appendectomy arm did take more sick leave (11 days more) compared with those in the antibiotic group.

“This long-term follow-up supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis,” concluded the authors.

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