A recent trial was unable to demonstrate noninferiority of antibiotics relative to surgery for the treatment of computed tomography–confirmed uncomplicated acute appendicitis (Salminen P et al. JAMA. 2015;313[23]:2340-2348).
The trial randomly assigned 530 patients to receive either antibiotics or an appendectomy, and tracked patient outcomes 1 year after intervention. Those in the antibiotic group received 3 days of intravenous ertapenem followed by 7 days of oral levofloxacin and metronidazole. Nearly all (99.6%) of the patients in the surgical group underwent successful appendectomy. Of those randomized to receive antibiotics, 27.3% underwent appendectomy within 1 year of their initial presentation. In an intention-to-treat analysis, the success rates between treatment groups differed by −27%, falling short of the prespecified minimal clinically important difference of 24% indicating noninferiority of the antibiotic intervention.