In managing acute uncomplicated appendicitis, patient outcomes are clearly the highest priority. Acute appendicitis ranks among the most common surgical emergencies globally, with an estimated lifetime incidence of 7% to 8% and a peak occurrence between 20 and 40 years of age.
The 2015 Appendicitis Acuta (APPAC) trial, in which adult participants with acute uncomplicated appendicitis without appendicolith were randomized to either open appendectomy or antibiotics (intravenous ertapenem for 3 days followed by 7 days of oral levofloxacin and metronidazole), demonstrated that 72.7% of patients treated with antibiotics did not require an appendectomy within the first year. The antibiotic treatment success rate was 63% at 2 years, 62% at 3 years, and 61% at 5 years.
Similarly, the 2020 Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial, which included patients with appendicolith, demonstrated that antibiotics were noninferior to appendectomy; 60% of patients in the antibiotic group did not require an appendectomy by 1 year, 54% by 2 years, and 51% at 3 and 4 years.
JAMA (Journal of the American Medical Association) published a clinical update in Research Highlights on 24 Mar 2026.
The item focuses on Medical vs Surgical Management of Acute Appendicitis.
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