Oral Antibiotics for Uncomplicated Acute Appendicitis: The Role of Extended-Spectrum Beta-Lactamase Risk Factor Stratification
Abstract
The World Society of Emergency Surgery 2020 guidelines recommend antibiotics as an effective and safe alternative to appendectomy for managing patients with computed tomography-confirmed uncomplicated acute appendicitis without appendicolith [1]. The safe avoidance of hospitalization for surgical patients is an important task during the coronavirus disease 2019 (COVID-19) pandemic, therefore this recommendation was also acknowledged by the American College of Surgeons (COVID-19 Guideline for Triage of Emergency General Surgery Patients) [2]. However, up to now, the optimum antibiotic regimen for the non-operative management of uncomplicated acute appendicitis has not been defined [1]. The results of the Appendicitis Acute (APPAC) II randomized controlled trial, comparing 7 days of oral moxifloxacin with 2 days of intravenous ertapenem followed by 5 days of oral levofloxacin and metronidazole, have been recently published [3]. This study showed that antibiotic therapy resulted in success rates at 1 year greater than 65% in both groups (70.2% for patients treated with oral antibiotics and 73.8% for patients treated with intravenous followed by oral antibiotics), but failed to demonstrate noninferiority (P = 0.26) of the only oral moxifloxacin regimen as compared to sequential intravenous to oral antibiotic treatment. Moxifloxacin has the advantage of once daily administration exerting an excellent oral bioavailability of 86% [4], and was selected as a broad-spectrum antibiotic…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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