Antibiotics may be a feasible alternative to surgery for patients with uncomplicated acute appendicitis as per a 5-year follow-up data from a randomized trial.

The researchers published the results online today in JAMA.

Although appendectomy has been the mainstay of treatment for acute appendicitis for more than 100 years, recent advances in diagnostic imaging and antibiotic therapies have allowed clinicians to consider antibiotic treatment as a viable alternative strategy in some cases in the trial 73% of all patients with acute uncomplicated appendicitis who received antibiotics alone did not require surgery at 1-year follow-up.

The randomized Appendicitis Acuta trial was conducted at 6 hospitals in Finland and enrolled 530 adults (329 men; 201 women) with uncomplicated acute appendicitis. Of those, 273 underwent appendectomy (median age, 35 years) and 257 initially received antibiotic treatment (median age, 33 years).

With 5 years of follow-up, 3 patients had died: 2 in the appendectomy group and 1 in the antibiotics group. However, none of the deaths was considered related to the trial.

Among the 257 patients who initially received antibiotics, 100 underwent appendectomy during follow-up. Of those, 70 experienced their recurrent appendicitis within 1 year of the first episode and 30 patients required an appendectomy at between 1 and 5 years

The cumulative incidence of recurrent appendicitis among patients who initially received antibiotics alone was 34.0% at 3 years, 37.1% at 4 years, and 39.1% at 5 years.