#3-23E. A Decade of Data: Antibiotics for Uncomplicated Appendicitis (JAMA, 2026)

Is immediate surgery truly mandatory for uncomplicated acute appendicitis? We explore the landmark 10-year follow-up of the APPAC randomized clinical trial published in JAMA, which assesses the long-term durability of antibiotic therapy versus appendectomy in adults with CT-confirmed uncomplicated appendicitis. The results are compelling: the cumulative appendectomy rate in the antibiotic group was 44.3% at 10 years, meaning the majority of patients successfully avoided surgery over a decade. Furthermore, MRI follow-up confirmed that non-operative management did not significantly risk missing appendiceal neoplasms. When critically appraising this paper, however, it is important to note that the study protocol mandated appendectomy for any suspected recurrence, which likely inflated the surgical rate with cases that may not have been true histological recurrences. For the practicing physician, these findings are vital for shared decision-making; you can now confidently inform patients that while late recurrence is possible, antibiotics represent a safe, durable alternative to surgery, allowing for evidence-based treatment choices.

Citation: Salminen P, et al. Antibiotic Therapy for Uncomplicated Acute Appendicitis Ten-Year Follow-Up of the APPAC Randomized Clinical Trial. JAMA. 2026. DOI: 10.1001/jama.2025.25921

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