Study: Outpatient antibiotic management of appendicitis

Editor's Note

Managing appendicitis with antibiotics on an outpatient basis shows promise as a safe, effective, lower-cost alternative to surgery, this study finds.

Of 30 patients involved in the trial, 15 were randomized to antibiotics and 14 to appendectomy. A total of 14 patients in the antibiotic group were discharged from the emergency department, and all had symptom resolution. Patients in the antibiotic group had less pain and disability.

At 1 month, major complications occurred in two appendectomy patients and one antibiotic patient. During 12-month follow-up, two in the antibiotic group developed appendicitis−one was treated successfully with antibiotics, and one had an appendectomy.

The researchers will be comparing outcomes in more than 1,500 patients in a randomized multi-center clinical trial of antibiotics vs appendectomy. Patients will be followed for a year or more.

Randomized trials suggest that nonoperative treatment of uncomplicated appendicitis with antibiotics-first is safe. No trial has evaluated outpatient treatment and no US randomized trial has been conducted, to our knowledge. This pilot study assessed feasibility of a multicenter US study comparing antibiotics-first, including outpatient management, with appendectomy.