Long-term data support option of antibiotics for appendicitis

Initial treatment with antibiotics is a viable option for uncomplicated acute appendicitis in adult patients, researchers reported in JAMA on January 21, 2026.

“What is the long-term appendicitis recurrence and appendectomy rate in adult patients with uncomplicated acute appendicitis treated with antibiotics?,” the authors asked. “In this 10-year observational follow-up of patients initially treated with antibiotics for uncomplicated acute appendicitis, the true appendicitis recurrence rate (appendicitis at histopathology) was 37.8% and the cumulative appendectomy rate was 44.3%,” they said.

The investigators evaluated data from the ten-year observational follow-up of subjects enrolled in the Appendicitis Acuta (APPAC) multicenter randomized clinical trial comparing appendectomy with antibiotics at six Finnish hospitals from November 2009 to June 2012.

Investigators in the APPAC trial randomized 530 subjects (aged 18-60 years) with uncomplicated acute appendicitis to appendectomy (n = 273) or antibiotics (n = 257). The last follow-up took place on April 29, 2024.

At 10-year follow-up, the data on 253/257 subjects (98.4%) randomized to receive antibiotics for appendicitis revealed a recurrence rate of 37.8% and a cumulative appendectomy rate of 44.3%. (112/253).

The authors concluded, “Long-term follow-up of patients with uncomplicated acute appendicitis supports the use of antibiotics as an option for uncomplicated acute appendicitis in adult patients.”

In a related editorial, Anthony Charles, MD, professor of surgery at the University of Vermont in Burlington said, “In this study, after successful antibiotic treatment, 90.9% of patients would again select antibiotics. However, less than one-half of the patients who underwent appendectomy after receiving antibiotics alone stated that they would again choose antibiotics in the future. Unfortunately, determining the factors predictive of recurrence in patients initially treated with antibiotics is challenging.”