A recently published randomized trial comparing antibiotic therapy with appendectomy in adult patients with appendicitis demonstrated that antibiotics were noninferior to appendectomy on the basis of results of a standard health-status measure at 30 days.

This was a non-blinded, noninferiority, randomized trial in 1552 patients with appendicitis at 25 U.S. centers; 776 were assigned to receive antibiotics, and 776 were assigned to undergo appendectomy. The primary outcome, the mean 30-day European Quality of Life–5 Dimensions (EQ-5D) questionnaire score, was consistent with noninferiority of antibiotics to appendectomy. Complications were more common in the antibiotics group than in the appendectomy group (8.1 versus 3.5 per 100 participants, respectively).

In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith.

Flum DR, Davidson GH, Monsell SE, et al. A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis. NEJM October 5, 2020 [online] DOI: 10.1056/NEJMoa2014320. Available at: click here. Accessed October 12, 2020.