Results of a five-year follow-up of patients from the Appendicitis Acuta (APPAC) trial, published in JAMA, support the feasibility of antibiotic treatment as an alternative for surgery for uncomplicated acute appendicitis. While short-term results have previously supported the use of antibiotics, less is known about long-term outcomes.
The APPAC trial included 530 patients in Finland with uncomplicated acute appendicitis who were randomised to undergo appendectomy (n=273) or to receive antibiotic therapy (n=257).
The authors found the cumulative incidence of recurrent appendicitis was 27.3 per cent at one year, 34 per cent at two years, 35.2 per cent at three years, 37.1 per cent at four years, and 39.1 per cent at five years.
One-hundred patients in the antibiotic group underwent appendectomy after five years. No appendicitis was found in seven of these patients.
The overall complication rate was 24.4 per cent in the appendectomy group and 6.5 per cent in antibiotic group (P<.001 patient initially treated with antibiotics who later developed recurrent appendicitis had any complications related to the delay in surgery.>
The authors said future research should investigate protocols for further imaging or antibiotic treatment for patients who develop recurrent appendicitis after initial treatment with antibiotics.