Finland: Adults with uncomplicated acute appendicitis treated with oral antibiotics versus IV followed by oral antibiotics had almost equal treatment success, finds a recent study in the journal JAMA.
In patients with uncomplicated acute appendicitis, antibiotics are an safe and effective alternative to appendectomy for the management of the condition, but the optimal antibiotic regimen is not known. Considering the same, Suvi Sippola, Turku University Hospital, Turku, Finland, and colleagues aimed to compare oral antibiotics with combined intravenous followed by oral antibiotics in the management of computed tomography–confirmed uncomplicated acute appendicitis.
For the purpose, the researchers designed the Appendicitis Acuta (APPAC) II -- a multicenter, open-label, noninferiority randomized clinical trial was conducted from April 2017 until November 2018 in 9 Finnish hospitals. The trial enrolled a total of 599 patients (aged 18 to 60 years) with computed tomography–confirmed uncomplicated acute appendicitis. The last date of follow-up was November 29, 2019.
Patients randomized to receive oral monotherapy (n = 295) received oral moxifloxacin (400 mg/d) for 7 days. Patients randomized to receive intravenous antibiotics followed by oral antibiotics (n = 288) received intravenous ertapenem (1 g/d) for 2 days followed by oral levofloxacin (500 mg/d) and metronidazole (500 mg 3 times/d) for 5 days. Among 599 patients who were randomized (mean [SD] age, 36 [12] years; 263 [44%] women), 581 (99.7%) were available for the 1-year follow-up.
The primary end point was treatment success (≥65%) for both groups, defined as discharge from hospital without surgery and no recurrent appendicitis during 1-year follow-up, and to determine whether oral antibiotics alone were noninferior to intravenous and oral antibiotics, with a margin of 6% for difference.
Key findings of the study include:
- The treatment success rate at 1 year was 70.2% for patients treated with oral antibiotics and 73.8% for patients treated with intravenous followed by oral antibiotics.
- The difference was −3.6% with the confidence limit exceeding the noninferiority margin.
"Patients with acute, uncomplicated appendicitis treated with oral antibiotics alone met the prespecified threshold for treatment success, but failed to demonstrate noninferiority relative to systemic antibiotics followed by oral antibiotics," concluded the authors.
"Effect of Oral Moxifloxacin vs Intravenous Ertapenem Plus Oral Levofloxacin for Treatment of Uncomplicated Acute Appendicitis: The APPAC II Randomized Clinical Trial," is published in the journal JAMA.
DOI: https://jamanetwork.com/journals/jama/fullarticle/2775227
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.