To the Editor We believe the results of the APPAC trial1 should be interpreted and used with caution despite it being a randomized trial. First, there is concern over the increasing global problem of antibiotic resistance2; triple therapy, including broad-spectrum carbapenem antibiotics, such as ertapenem, for appendicitis seems like overtreatment. Use of carbapenem antibiotics (once reserved for patients in the intensive care unit setting against multiresistant gram-negative bacteria) have produced resistant Enterobacteriaceace.
Maryam Alfa-Wali, Paul Toomey, Ash Gupta. Treatment of Uncomplicated Acute Appendicitis. JAMA. 2015;314(13):1402–1403. doi:10.1001/jama.2015.11423