Effect of Oral Moxifloxacin vs Intravenous Ertapenem Plus Oral Levofloxacin for Treatment of Uncomplicated Acute Appendicitis: The APPAC II Randomized Clinical Trial
RCT (n=599) found comparable success rates (discharge without surgery and no recurrence within 1 year) for 7d oral moxifloxacin vs 2d IV ertapenem followed by 5d oral levofloxacin & metronidazole (70.2% vs 73.8%) but failed to establish non-inferiority of oral treatment.
Source:
Journal of the American Medical Association
SPS commentary:
Commentary states that recent evidence has suggested antibiotics alone could be offered as a treatment option to patients with uncomplicated appendicitis, and that this study, although failing to establish non-inferiority of the oral regimen, found comparable success rates for antibiotic treatment as compared to previous research. It concludes that patients with uncomplicated appendicitis should be offered a treatment choice between surgery and antibiotics alone, and the key to moving forward is getting that evidence into practice. Successful implementation studies that address and mitigate these barriers will promote evidence uptake and allow for an informed decision-making process as part of clinical care.