Oral antibiotic therapy without hospitalization in uncomplicated acute appendicitis: long-term results from a retrospective cohort study

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PURPOSE: Antibiotic therapy may be an alternative in the treatment of uncomplicated appendicitis. The primary concern about antibiotic therapy is the need for appendectomy due to recurrent acute appendicitis after treatment. The optimal antibiotic choice, route of administration, and duration of treatment remain controversial. We aimed to demonstrate the long-term success of oral antibiotic therapy in uncomplicated appendicitis. METHODS: This was a single-center retrospective study including all patients diagnosed with uncomplicated acute appendicitis between January 2020 and December 2022, who were discharged from the emergency department on oral antibiotics without hospitalization. Treatment success was defined as the absence of appendectomy during follow-up. We reported long-term treatment success rates of oral antibiotic therapy. In addition, factors that may affect treatment success were evaluated. RESULTS: A total of 99 patients were included in the study. At 1 year, the treatment success rate was 76% (95% CI = 66-83%). At a median follow-up of 34 months, 70% (95% CI = 60-78%) remained free of surgery. The Kaplan-Meier analysis revealed that 80% of appendectomies due to recurrent acute appendicitis occurred within the first 10 months. There were no significant differences between patients who required appendectomy and those who did not regarding age, sex, WBC count, neutrophil-to-lymphocyte ratio, appendix diameter, or previous intravenous antibiotic use. CONCLUSION: With a median follow-up of 34 months, oral antibiotic-only treatment prevented appendectomy in 70% of patients. Larger, prospective randomized studies are needed to identify factors influencing treatment success.

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