For uncomplicated acute appendicitis treatment with oral ant
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Patients with acute, uncomplicated appendicitis treated with oral antibiotics alone met the prespecified threshold for treatment success but failed to demonstrate non-inferiority relative to systemic antibiotics followed by oral antibiotics.

Antibiotics are an effective and safe alternative to appendectomy for managing uncomplicated acute appendicitis, but the optimal antibiotic regimen is not known. The objective of the study was to compare oral antibiotics versus combined intravenous followed by oral antibiotics in the management of computed tomography–confirmed uncomplicated acute appendicitis.

A total of 599 patients aged 18 to 60 years with computed tomography–confirmed uncomplicated acute appendicitis were enrolled in the trial. Patients randomized to receive oral monotherapy (n = 295) received oral moxifloxacin (400 mg/d) for 7 days. Patients randomized to receive intravenous antibiotics followed by oral antibiotics (n = 288) received intravenous ertapenem (1 g/d) for 2 days followed by oral levofloxacin (500 mg/d) and metronidazole (500 mg 3 times/d) for 5 days.

The primary endpoint was treatment success (65%) for both groups, defined as discharge from hospital without surgery and no recurrent appendicitis during a 1-year follow-up, and to determine whether oral antibiotics alone were non-inferior to intravenous and oral antibiotics.

The treatment success rate at 1 year was 70.2% for patients treated with oral antibiotics and 73.8% for patients treated with intravenous followed by oral antibiotics.

Conclusively, among adults with uncomplicated acute appendicitis, treatment with 7 days of oral moxifloxacin compared with 2 days of intravenous ertapenem followed by 5 days of levofloxacin and metronidazole resulted in treatment success rates greater than 65% in both groups but failed to demonstrate noninferiority for treatment success of oral antibiotics compared with intravenous followed by oral antibiotics.

JAMA Network
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