Infectious Disease

Oral antibiotics alone that aren’t inferior to IV, oral antibiotics for acute appendicitis

February 14, 2021

2 min read

Source / information

Published by:

Disclosure:
Salminen does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

ADD SUBJECT TO EMAIL ALARMS

Receive an email when new articles are published

Please enter your email address to receive an email when new articles are published . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If you continue to have this problem, please contact customerservice@slackinc.com.

Back to Healio

In adults with uncomplicated acute appendicitis, treatment with 7 days of oral moxi fl oxacin is not inferior to a combination of intravenous and oral antibiotics, researchers reported.

The results are from the Appendicitis Acuta (APPAC) II study, a randomized clinical trial conducted in Finland. The first APPAC study compared appendectomy with antibiotics for CT-confirmed uncomplicated acute appendicitis and showed that antibiotics “were a safe and effective treatment option at both 1 and 5 years” Paulina Salminen, MD, PhD, Professor of Surgery at the University of Turku and Turku University Hospital.

For APPAC II, “we wanted to evaluate the optimization of antibiotic treatment,” Salminen told Healio.

According to Salminen, patients in the original APPAC study were given antibiotics with three intravenous doses for 10 days. In APPAC II, however, Salminen and colleagues compared a combination of intravenous antibiotics followed by oral antibiotics with oral antibiotics only with a treatment duration of 7 days.

“Given that the nonsurgical treatment of uncomplicated acute appendicitis is well established and has now been confirmed by multiple clinical studies, the main objective of this APPAC II study was to demonstrate the ability of oral antibiotics to treat acute appendicitis alone and its non-inferiority between these antibiotics to evaluate treatments, “said Salminen.

The researchers included 583 adults with uncomplicated acute appendicitis from nine Finnish hospitals who were treated with either 7 days of oral moxi fl oxacin or 2 days of intravenous ertapenem, followed by 5 days of levofloxacin and metronidazole.

According to the study, 581 (99.7%) of 599 randomly assigned patients were available for the 1-year follow-up. The treatment success rate after 1 year was 70.2% for patients treated with oral antibiotics only, and 73.8% for patients treated with IV followed by oral antibiotics, a result that did not inferior to treatment success purely oral treatment showed. The researchers found.

Salminen said the success rates were “very consistent” with the initial results of the APPAC study and with other recent studies when the same criteria were used to define uncomplicated and complicated acute appendicitis.

“Accurate preventive diagnosis of the severity of appendicitis is of great importance because uncomplicated and complicated acute appendicitis are clinically two different diseases. The patients in this APPAC II study had a CT-confirmed uncomplicated acute appendicitis (no appendix, no perforation, no abscess, no suspected tumor), ”said Salminen. “Treatment with antibiotics, and now only oral antibiotics, is a safe and efficient treatment alternative for CT-confirmed uncomplicated acute appendicitis.”

In a related editorial Peter C. Minneci, MD, MHSc, and Katherine J. Deans, MD, MHSc, Both from Nationwide Children’s Hospital in Columbus, Ohio said, “This is an important first study to better define treatment strategies as it opens up a greater potential scope in the outpatient setting.”

Salminen said a shorter hospital stay or even outpatient treatment for antibiotic therapy could further improve cost savings, patient satisfaction and quality of life, adding that “given the high prevalence of acute appendicitis, particularly during the COVID-19 pandemic, the feasibility is made and effectiveness The safety of treatment options that allow avoidance of hospitalizations and the possibility of diverting health care resources are critical. “

References:

Minneci PC et al. JAMA. 2021; doi: 10.1001 / jama.2020.23607.

Sippola S. et al. JAMA. 2021; doi: 10.1001 / jama.2020.23525.

ADD SUBJECT TO EMAIL ALARMS

Receive an email when new articles are published

Please enter your email address to receive an email when new articles are published . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If you continue to have this problem, please contact customerservice@slackinc.com.

Back to Healio

Related Articles