Antibiotics vs Surgery in Acute Appendicitis

N/AActive Not RecruitingNCT07492329

Sebahattin Celik MD400 enrolled

Overview

The aim of this study is to identify clinical, laboratory, and imaging parameters that can predict the most appropriate treatment strategy in patients diagnosed with acute appendicitis. Although appendectomy remains the gold standard treatment, selected patients may be successfully treated with antibiotic therapy. Therefore, determining which patients are more likely to benefit from surgical treatment and which may be managed with antibiotics represents an important clinical challenge. This study is designed as a single-center prospective observational study. Patients aged 18 years and older who are diagnosed with acute appendicitis between 2024 and 2025 will be included. Demographic characteristics, diagnostic modalities, laboratory parameters, clinical scoring systems (Ohmann score and Alvarado score), imaging findings, and treatment modality (antibiotic therapy or appendectomy) will be prospectively recorded. Patients treated with antibiotics will be followed to determine whether appendectomy becomes necessary later and to evaluate the time interval between diagnosis and surgery. Patients with other causes of acute abdomen or those with incomplete clinical data will be excluded from the study. The primary aim of the study is to determine parameters that can predict treatment selection and clinical outcomes. Sensitivity, specificity, and predictive values of the evaluated parameters will be calculated to assess their usefulness in guiding treatment decisions.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

400

Conditions

Acute Appendicitis

Interventions

surgery (any volume) and / or pharmaceuticals treatment initiated or planned or only dynamic observation, in accordance with current clinical guidelinesPROCEDURE

Surgical appendectomy performed according to clinical guidelines

AntibioticDRUG

Antibiotic therapy administered for the treatment of acute appendicitis according to current clinical guidelines.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥18 years * Diagnosis of acute appendicitis * Patients managed either with antibiotic therapy or appendectomy * Availability of clinical, laboratory, and imaging data Exclusion Criteria: * Age \<18 years * Presence of another cause of acute abdomen (e.g., ovarian torsion, gastrointestinal perforation, etc.) * Patients who did not receive either antibiotic therapy or surgical treatment (treatment refusal) * Patients hospitalized for another primary medical condition * Patients receiving antibiotics for another infection at the time of diagnosis * Incomplete or inaccessible clinical data

Outcomes

Primary Outcomes

Treatment success of the initial management strategy

Treatment success is defined as the proportion (%) of patients who achieve resolution of acute appendicitis without the need for additional surgical or interventional procedures during the follow-up period. For patients treated with antibiotics, success is defined as the resolution of clinical symptoms (abdominal pain, fever), normalization of inflammatory markers (white blood cell count, C-reactive protein), and no requirement for appendectomy. For patients treated with appendectomy, success is defined as the completion of surgery without major postoperative complications (Clavien-Dindo grade ≥ III) and no need for reintervention.

Time frame: Up to 1 years follow-up

Secondary Outcomes

Need for delayed appendectomy

Proportion of patients initially treated with antibiotics who subsequently require appendectomy.

Time frame: Up to 1 years