Trial reportThe British journal of surgery2022
Antibiotics versus placebo in adults with CT-confirmed uncomplicated acute appendicitis (APPAC III): randomized double-blind superiority trial.
Trial report in The British journal of surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03234296 (Antibiotic Therapy vs. Placebo in the Treatment of Acute Uncomplicated Appendicitis), which is not on this map. Cited by 27 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Antibiotic Therapy vs. Placebo in the Treatment of Acute Uncomplicated Appendicitis: a Randomized Double-blinded Placebo-controlled Trial - APPAC III Study
Who cites it
27 citing papers in PubMed, 4 syntheses or guidelines pooled it, 51 citations in OpenAlex.
- Effect of antibiotic therapy versus no antibiotics on nonoperative management outcomes in uncomplicated appendicitis: A systematic review and meta-analysis.International journal of colorectal disease · 2026Pooled it
- Swedish national guidelines for diagnosis and management of acute appendicitis in adults and children.BJS open · 2025Guideline
- Diagnostic value of the appendicitis inflammatory response (AIR) score. A systematic review and meta-analysis.World journal of emergency surgery : WJES · 2025Pooled it
- Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid-19 Pandemic: a Systematic Review and Meta-analysis.World journal of surgery · 2023Pooled it
- Uncomplicated and Complicated Acute Appendicitis Induce Different Cytokine Patterns.APMIS : acta pathologica, microbiologica, et immunologica Scandinavica · 2026Trial
- Prognostic factors associated with primary non-responsiveness to antibiotics and appendicitis recurrence for CT-diagnosed uncomplicated acute appendicitis: secondary analysis of two randomized clinical trials.The British journal of surgery · 2025Trial
- Outpatient non-operative treatment of uncomplicated acute appendicitis: meta-analysis.BJS open · 2026Article
- Endoscopic direct-vision therapy vs. antibiotics for acute uncomplicated appendicitis: a retrospective cohort study.International journal of colorectal disease · 2026Article
- Non-operative Management of Uncomplicated Appendicitis: A Review of Indications, Safety, and Clinical Algorithms.Cureus · 2026Review
- A National survey of surgeons' perspectives on the treatment of adults with acute appendicitis.Langenbeck's archives of surgery · 2026Article
- The rate of complicated appendicitis during a nonpharmaceutical intervention in two territories with different COVID-19 incidence.BMC gastroenterology · 2025Article
- Appendicitis.Nature reviews. Disease primers · 2025Review
- Complicated appendicitis: value of inflammatory markers based on EAES 2015 guidelines.Surgical endoscopy · 2025Article
- Acute appendicitis and its treatment: a historical overview.International journal of colorectal disease · 2025Article
- Clinical-radiomics models with machine-learning algorithms to distinguish uncomplicated from complicated acute appendicitis in adults: a multiphase multicenter cohort study.Gastroenterology report · 2025Article
- Surgical delay in appendicitis among children: the role of social vulnerability.Frontiers in pediatrics · 2025Article
- Mean Platelet Volume as an Emerging Biomarker for Diagnosing Acute Appendicitis: A Retrospective Study.Cureus · 2024Article
- Impact of an appendicolith and its characteristics on the severity of acute appendicitis.BJS open · 2024Article
- Systemic immune-inflammation index combined with pediatric appendicitis score in assessing the severity and prognosis for paediatric appendicitis.World journal of gastrointestinal surgery · 2024Article
- Appendicolith classification: physical and chemical properties of appendicoliths in patients with CT diagnosed acute appendicitis - a prospective cohort study.BMJ open gastroenterology · 2024Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNon-operative management of uncomplicated acute appendicitis is an option, but omission of antibiotics from the regimen has not been tested.
methodsA double-blind, placebo-controlled, superiority RCT in adults with CT-confirmed uncomplicated acute appendicitis was designed to compare placebo with antibiotics (intravenous ertapenem followed by oral levofloxacin and metronidazole). The primary endpoint was treatment success (resolution resulting in discharge without appendicectomy within 10 days); secondary outcomes included pain scores, complications, hospital stay, and return to work.
resultsFrom May 2017 to September 2020, 72 patients with a mean(s.d.) age of 37.5 (11.1) years were recruited at five hospitals. Six were excluded after randomization (5 early consent withdrawals, 1 randomization protocol violation), 35 were assigned to receive antibiotics, and 31 to receive placebo. Enrolment challenges (including hospital pharmacy resources in an acute-care surgery setting) meant that only the lowest sample size of three predefined scenarios was achieved. The 10-day treatment success rate was 87 (95 per cent c.i. 75 to 99) per cent for placebo and 97 (92 to 100) per cent for antibiotics. This clinical difference of 10 (90 per cent c.i. -0.9 to 21) per cent was not statistically different for the primary outcome (1-sided P = 0.142), and secondary outcomes were similar.
conclusionThe lack of antibiotic superiority statistically suggests that a non-inferiority trial against placebo is warranted in adults with CT-confirmed mild appendicitis. Registration number: EudraCT 2015-003634-26 (https://eudract.ema.europa.eu/eudract-web/index.faces), NCT03234296 (http://www.clinicaltrials.gov).
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.