Outpatient Antibiotic Management of Appendicitis Feasible for Selected Adults

FRIDAY, July 15, 2022 (HealthDay News) -- Outpatient management seems safe for selected adults receiving antibiotic treatment for acute appendicitis, according to a study published online July 1 in JAMA Network Open.

David A. Talan, M.D., from the Ronald Reagan UCLA Medical Center in Los Angeles, and colleagues examined the use and safety of outpatient management of acute appendicitis in a secondary analysis of the Comparison of Outcomes of Antibiotic Drugs and Appendectomy trial, involving 776 adults with imaging-confirmed appendicitis who received antibiotics at 25 U.S. hospitals from May 1, 2016, to Feb. 28, 2020.

The researchers found that 5.4 percent of the participants underwent appendectomy within 24 hours and 1.0 percent did not receive their first dose of antibiotics within 24 hours and were excluded, yielding 726 participants in the study population. Of these participants, 46.1 and 53.9 percent were discharged within 24 hours (outpatients) and after 24 hours (inpatients), respectively. Serious adverse events (SAEs) occurred in 0.9 and 1.3 per 100 outpatients and inpatients, respectively, over seven days; in the appendicolith subgroup, SAEs occurred in 2.3 and 2.8 per 100 outpatients and inpatients, respectively. During this period, appendectomy occurred in 9.9 and 14.1 percent of outpatients and inpatients, respectively; the difference in incidence was similar in an adjusted analysis. Appendectomies occurred in 12.6 and 19.0 percent of outpatients and inpatients, respectively, at 30 days. Compared with inpatients, outpatients missed fewer workdays (2.6 versus 3.8) and had a similar frequency of return health care visits, as well as high satisfaction and EuroQol 5-dimension scores.

"Most patients who choose antibiotics can avoid hospitalization without incurring increased risk of serious complications or appendectomy," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text