Antibiotics versus appendectomy for appendicitis

To assess the efficacy of antibiotic therapy compared with appendectomy for the treatment of appendicitis, a noninferiority trial in 1,552 adults with appendicitis or an appendicolith was conducted at 25 centres in the USA. Patients were randomized to receive either a 10-day course of antibiotics or to undergo surgery. Antibiotics were noninferior to appendectomy, based on the primary outcome of 30-day European Quality of Life–5 Dimensions questionnaire scores (mean difference, 0.01 points; 95% CI −0.001 to 0.03). Of the antibiotics group, 41% of those with an appendicolith and 25% of those without had undergone an appendectomy by 90 days after randomization. Complications were more common in the antibiotics group than in the appendectomy group.