Oral Antibiotic Outpatient Therapy vs. Placebo in the Treatment of Uncomplicated Acute Appendicitis

Summary

APPAC IV, a randomized double-blind multicenter clinical trial comparing once daily oral moxifloxacin with placebo in an outpatient setting aims to evaluate whether antibiotics and hospitalization or both can be omitted in the treatment of uncomplicated appendicitis further significantly increasing cost savings and patient satisfaction. This is a direct research continuum to the previous trial triad: APPAC, APPAC II and APPAC III, which have already established that the majority of patients with uncomplicated acute appendicitis can be safely treated without surgery. The APPAC IV trial is based on a novel concept and approach to further optimize the nonoperative treatment of uncomplicated acute appendicitis with a high potential in resulting in major health care cost savings and potentially also in significant reduction of antibiotic use in an extremely common surgical emergency.

Timeline

Start

2024-01

Primary completion

2025-12

Completion

2045-12

Publications

• Lund H, Haijanen J, Suominen S, Hurme S, Sippola S, Rantanen T, Rautio T, Mattila A, Pinta T, Nordstrom P, Kossi J, Ilves I, Salminen P. A randomized double-blind noninferiority clinical multicenter trial on oral moxifloxacin versus placebo in the outpatient treatment of uncomplicated acute appendicitis: APPAC IV study protocol. Scand J Surg. 2025 Mar;114(1):3-12. doi: 10.1177/14574969241293018. Epub 2024 Dec 5.

Drugs

Indications