Infectious Disease
RCT
● RCT
Antibiotics for Appendicitis: 37.8% Recurrence, 44.3% Appendectomy at 10 Years
JAMA
Published March 27, 2026
Salminen Paulina, Salminen Roosa, Kallio Johanna, Hurme Saija, Nordström Pia, Rantanen Tuomo, Paajan…
PubMed ↗
NCT01022567 ↗
DOI ↗
The APPAC randomized clinical trial provides a 10-year follow-up analysis of patients with uncomplicated acute appendicitis treated with antibiotics versus appendectomy. Conducted across six Finnish hospitals, 530 patients aged 18-60 years were randomized to either open appendectomy or a regimen of intravenous ertapenem sodium followed by oral levofloxacin and metronidazole. The primary endpoint was the 10-year recurrence rate of appendicitis in the antibiotic group, which was 37.8% (95% CI, 31.6%-44.1%). The cumulative appendectomy rate in this group was 44.3% (95% CI, 38.2%-50.4%). Secondary endpoints included a comparison of complication rates, which were significantly lower in the antibiotic group (8.5%) compared to the appendectomy group (27.4%, P<.001). Quality of life assessments showed no significant difference between the two groups (P=0.18). Safety profiles favored antibiotics, with fewer complications reported. These findings suggest that antibiotics remain a viable option for treating uncomplicated acute appendicitis, offering a non-surgical alternative with lower complication rates.
AI Accuracy Review: 9/10
· Auto-published
Imagine facing a painful condition like appendicitis and wondering if surgery is your only option. Uncomplicated acute appendicitis can be tricky to treat, often leading to an appendectomy, which is the surgical removal of the appendix. However, a long-term study shows that antibiotics can effectively manage this condition. In a group of patients treated with antibiotics, about 38% had a recurrence of appendicitis over 10 years, but nearly half avoided surgery entirely. This means that for many, antibiotics can be a viable option, sparing them from the risks and recovery time associated with surgery. It's important to note that while the overall quality of life was similar between those treated with antibiotics and those who had surgery, some patients did experience complications from both treatments. As we move forward, these findings encourage patients and doctors to consider antibiotics as a first-line treatment for uncomplicated appendicitis, but ongoing discussions about individual risks and benefits remain crucial.
What this means for you: Antibiotics can be a safe option for uncomplicated appendicitis, offering hope for those avoiding surgery.
View Original Abstract ↓
IMPORTANCE: Antibiotic therapy is effective and safe for uncomplicated acute appendicitis in adults, but randomized clinical trial results exceeding 5 years are missing.
OBJECTIVE: To determine the 10-year appendicitis recurrence and appendectomy rate in patients with uncomplicated appendicitis treated with antibiotics.
DESIGN, SETTING, AND PARTICIPANTS: Ten-year observational follow-up of patients in the Appendicitis Acuta (APPAC) multicenter randomized clinical trial comparing appendectomy with antibiotics at 6 Finnish hospitals from November 2009 to June 2012, where 530 patients (aged 18-60 years) with uncomplicated acute appendicitis diagnosed by computed tomography were randomly assigned to appendectomy (n = 273) or antibiotics (n = 257). Last follow-up was April 29, 2024. This current analysis focused on assessing the 10-year appendicitis recurrence rate among patients assigned to antibiotics.
INTERVENTIONS: Open appendectomy vs antibiotics with intravenous ertapenem sodium (1 g/d) for 3 days followed by 7 days of oral levofloxacin (500 mg once daily) and metronidazole (500 mg 3 times/d).
MAIN OUTCOMES AND MEASURES: Prespecified 10-year secondary end points included late (after 1 year) appendectomy and appendicitis recurrence rate after antibiotics and complications. Post hoc outcomes included the detection of possible appendiceal tumors among patients in the antibiotic group undergoing appendectomy or with an intact appendix using magnetic resonance imaging. Additional post hoc outcomes were quality of life and patient satisfaction.
RESULTS: At 10-year follow-up, 253/257 patients (98.4%) randomized to receive antibiotics (median age, 33 years; 102 [40.3%] female) were assessed for appendicitis recurrence, with a true appendicitis recurrence rate (appendicitis at histopathology) of 37.8% (95% CI, 31.6%-44.1% [87/230]) and a cumulative appendectomy rate of 44.3% (95% CI, 38.2%-50.4% [112/253]). Overall, the 10-year cumulative complication rate in the group randomized to appendectomy was 27.4% (95% CI, 21.6%-33.3% [62/226]) and 8.5% (95% CI, 4.8%-12.1% [19/224]) in the group randomized to receive antibiotics (P < .001). There was no observed significant difference in quality of life between antibiotics and appendectomy (387/530; median health index value, 1.0 [95% CI, 1.0-1.0] for both groups; P = .18).
CONCLUSIONS AND RELEVANCE: Among patients initially treated with antibiotics for uncomplicated acute appendicitis, the rate of recurrence and appendectomy at 10-year follow-up supports the use of antibiotics as an option for uncomplicated acute appendicitis in adult patients.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01022567.
