Acute Appendicitis: Active Observation With and Without Antibiotics

NCT ID: NCT03985514

Last Updated: 2022-08-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

126 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-05-15

Study Completion Date

2022-06-30

Brief Summary

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This study evaluates if early provision of antibiotics is a superior treatment compared to "traditional wait and see" with regard to symptom relief for suspected acute uncomplicated appendicitis.

Detailed Description

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Recent long-term follow up results of antibiotic treatment of acute appendicitis in unselected populations indicate that approximately 70-80 % of patients respond to antibiotics, while the remaining 20-25% need an operation. Antibiotic treatment was associated with significantly fewer severe and non-severe complications compared to surgery. Therefore, antibiotic treatment can be regarded as safe and effective initial treatment of acute appendicitis based on evidence.

However, it remains to be evaluated to what extent antibiotic treatment is more effective compared to the most conservative application of procedures in the care of patients with acute appendicitis. A well- recognized approach in Sweden is watchful waiting at in-hospital conditions. A certain number of patients with suspected uncomplicated appendicitis will likely recover without any active treatment, but controlled evidence are lacking to what extent such recoveries may occur in the short- and long-term perspective.

The hypothesis is that antibiotic treatment is superior to active observation with regard to symptom relief at suspected acute appendicitis in selected patient groups.

Conditions

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Appendicitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Selected patients with assumed uncomplicated acute appendicitis are allocated to groups "Active observation" or "Antibiotic treatment" in a 1:1 ratio.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Antibiotic treatment

Patients will receive in-hospital intravenous antibiotics (Piperacillin/Tazobactam, 4 gram x 3), followed by 8-10 days of out-hospital oral antibiotic treatment (Ciprofloxacin 500 mgx2,Flagyl 400 mgx3). Surgery if no symptom relif occur.

Group Type ACTIVE_COMPARATOR

Antibiotic treatment (Piperacillin/Tazobactam, 4 gram x 3), followed by 8-10 days of out-hospital oral antibiotic treatment (Ciprofloxacin 500 mgx2,Flagyl 400 mgx3).

Intervention Type DRUG

Intravenous antibiotic treatment x 3, followed by oral antibiotics for 8-10 Days.

Clinical observation

Patients are followed by in-hospital "Active observation" (watchful waiting) according to clinical routine. Patients are observed until either, recovery and dismissal from hospital, or decision for intervention (surgery) is taken.

Group Type OTHER

Active observation

Intervention Type OTHER

In-hospital observation without antibiotics

Interventions

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Antibiotic treatment (Piperacillin/Tazobactam, 4 gram x 3), followed by 8-10 days of out-hospital oral antibiotic treatment (Ciprofloxacin 500 mgx2,Flagyl 400 mgx3).

Intravenous antibiotic treatment x 3, followed by oral antibiotics for 8-10 Days.

Intervention Type DRUG

Active observation

In-hospital observation without antibiotics

Intervention Type OTHER

Other Intervention Names

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Piperacillin/Tazobactam Ciprofloxacin Flagyl

Eligibility Criteria

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Inclusion Criteria

* Subjects with suspected appendicitis.
* Age\<60 years.
* C-reactive protein \< 60 mg/L.
* White blod cell Count (leucocytes) \< 13 e9 /L.

Exclusion Criteria

* Pregnant
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Vastra Gotaland Region

OTHER_GOV

Sponsor Role collaborator

Göteborg University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Kent Lundholm, Professor

Role: PRINCIPAL_INVESTIGATOR

Göteborg University

Locations

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Department of surgery, Sahlgrenska University Hospital

Gothenburg, , Sweden

Site Status

Countries

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Sweden

Other Identifiers

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App 2018

Identifier Type: -

Identifier Source: org_study_id

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