Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2021 Aug 1;274(2):240-247.
doi: 10.1097/SLA.0000000000004785.

A Randomized Clinical Trial Evaluating the Efficacy and Quality of Life of Antibiotic-only Treatment of Acute Uncomplicated Appendicitis: Results of the COMMA Trial

D Peter O'Leary  1 , Siun M Walsh  1 , Jarlath Bolger  1 , Chwanrow Baban  1 , Hilary Humphreys  2 , Sorcha O'Grady  1 , Aisling Hegarty  1 , Aoife M Lee  3 , Mark Sheehan  3 , Jack Alderson  3 , Ruth Dunne  3 , Martina M Morrin  3 , Michael J Lee  3 , Colm Power  1 , Deborah McNamara  1 , Niamh McCawley  1 , Will Robb  1 , John Burke  1 , Jan Sorensen  4 , Arnold D Hill  1
Affiliations
Randomized Controlled Trial

A Randomized Clinical Trial Evaluating the Efficacy and Quality of Life of Antibiotic-only Treatment of Acute Uncomplicated Appendicitis: Results of the COMMA Trial

D Peter O'Leary et al. Ann Surg. .

Abstract

Objective: Evaluate the efficacy and quality of life associated with conservative treatment of acute uncomplicated appendicitis.

Summary background data: Conservative management with antibiotics only has emerged as a potential treatment option for acute uncomplicated appendicitis. However the reported failure rates are highly variable and there is a paucity of data in relation to quality of life.

Methods: Symptomatic patients with radiological evidence of acute, uncomplicated appendicitis were randomized to either intravenous antibiotics only or undergo appendectomy.

Results: One hundred eighty-six patients underwent randomization. In the antibiotic-only group, 23 patients (25.3%) experienced a recurrence within 1 year following randomization. There was a significantly better EQ-VAS quality of life score in the surgery group compared with the antibiotic-only group at 3 months (94.3 vs 91.0, P < 0.001) and 12 months postintervention (94.5 vs 90.4, P < 0.001). The EQ-5D-3L quality-of-life score was significantly higher in the surgery group indicating a better quality of life (0.976 vs 0.888, P < 0.001). The accumulated 12-month sickness days was 3.6 days shorter for the antibiotics only group (5.3 vs 8.9 days; P < 0.01). The mean length of stay in both groups was not significantly different (2.3 vs 2.8 days, P = 0.13). The mean total cost in the surgery group was significantly higher than antibiotics only group (€4,816 vs €3,077, P < 0.001).

Conclusions: Patients with acute, uncomplicated appendicitis treated with antibiotics only experience high recurrence rates and an inferior quality of life. Surgery should remain the mainstay of treatment for this commonly encountered acute surgical condition.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Comment in

References

    1. Bhangu A, Søreide K, Di Saverio S, et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 2015; 386:1278–1287.
    1. Di Saverio S, Sibilio A, Giorgini E, et al. The NOTA Study (Non Operative Treatment for Acute Appendicitis): prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conservatively treated suspected appendicitis. Ann Surg 2014; 260:109–117.
    1. Flum DR. Clinical practice. Acute appendicitis—appendectomy or the “antibiotics first” strategy. N Engl J Med 2015; 372:1937–1943.
    1. Wu JX, Sacks GD, Dawes AJ, et al. The cost-effectiveness of nonoperative management versus laparoscopic appendectomy for the treatment of acute, uncomplicated appendicitis in children. J Pediatr Surg 2017; 52:1135–1140.
    1. Salminen P, Tuominen R, Paajanen H, et al. Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC randomized clinical trial. JAMA 2018; 320:1259–1265.

Publication types

Substances