Oral antibiotics alone noninferior to IV, oral antibiotics f
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Among adults with uncomplicated acute appendicitis, treatment with 7 days of oral moxifloxacin is not noninferior to a combination of IV and oral antibiotics, researchers reported.

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

The Appendicitis Acuta (APPAC) II multicenter, open-label, noninferiority randomized clinical trial was conducted. 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 end point was treatment success (more than 65%) for both groups, defined as discharge from hospital without surgery and no recurrent appendicitis during 1-year follow-up, and to determine whether oral antibiotics alone were noninferior to intravenous and oral antibiotics, with a margin of 6% for difference.

Results:
-- Among 599 patients who were randomized (mean age, 36 years; 263 women), 581 were available for the 1-year follow-up.

-- 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.

-- The difference was -3.6%, with the confidence limit exceeding the noninferiority margin.

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.

Source: https://jamanetwork.com/journals/jama/article-abstract/2775227
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