The APPAC trial compared antibiotic therapy (ertapenem 3 days then oral levofloxacin + metronidazole for 7 days) versus appendicectomy for uncomplicated acute appendicitis. What was the key 5-year outcome finding?

• A Antibiotic therapy was equivalent to appendicectomy with <5% recurrence at 5 years
• B Antibiotic therapy prevented appendicectomy in 90% of patients at 5 years with no increase in complicated appendicitis
• C Antibiotic treatment achieved a 73% success rate at 1 year, but 39% of initially treated patients required appendicectomy within 5 years; appendicectomy had a complication rate of 24% ✓
• D Appendicectomy had superior 5-year outcomes with no mortality; antibiotics failed in 60% at 1 year

Explanation

The APPAC (Antibiotic Therapy vs. Appendectomy for Treatment of Uncomplicated Acute Appendicitis) trial showed that at 1 year, 73% of antibiotic-treated patients did not require surgery; however, by 5 years, 39% ultimately underwent appendicectomy. Among those who initially failed antibiotic therapy or eventually required surgery, there was no increased rate of complicated appendicitis compared to immediate surgery. Appendicectomy itself had a ~24% complication rate. These data support antibiotics as a valid first-line option for uncomplicated appendicitis (CT-confirmed, no faecolith), with shared decision-making regarding the 39% probability of eventual surgery.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.