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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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Thursday, February 11, 2021

Uncomplicated Acute Appendicitis

REBEL EM - February 11, 2021 - By Salim Rezaie
Paper: Sippola S et al. Effect of Oral Moxifloxacin vs Intravenous Ertapenem Plus Oral Levofloxacin for Treatment of Uncomplicated Acute Appendicitis: The APPAC II Randomized Clinical Trial. JAMA 2021. PMID: 33427870
"Clinical Question: In acute uncomplicated appendicitis, is treatment with oral antibiotics alone non-inferior to a combination of IV followed by oral antibiotics?
Author Conclusion: “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.”
Clinical Take Home Point: Non-operative management of uncomplicated appendicitis is a feasible option in patients based on good evidence from the APPAC and CODA trials. Further defining optimal treatment strategies to minimize need for hospitalization should be the focus of future research in this area. Questions that remain include antibiotic duration, mode of antibiotic delivery, and the need for in-patient observation. The APPAC II trial is a nice start to answer some of these more nuanced questions. As we see more evidence and gain more experience with the management of uncomplicated acute appendicitis, this will help guide the optimal operative and non-operative management pathways. At this time PO only antibiotics for uncomplicated acute appendicitis appear to be promising, but not non-inferior with no discernible advantage."