- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00135603
Antibiotic Therapy Versus Appendectomy for Acute Appendicitis
A Prospective Randomized Multicentric Trial Comparing Amoxicillin/Clavulanate Potassium Therapy to Appendectomy for Acute Non Complicated Appendicitis
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Appendectomy is the most frequent intra-abdominal operation performed, accounting for the majority of admissions in a general surgery unit. Appendectomy has always been considered the cornerstone in the treatment of acute appendicitis.Nevertheless, the idea of a conservative treatment using antibiotics is not that recent. Current practices have proven the efficiency of antibiotic therapy in treating certain infectious abdominal conditions including: appendicular mass with or without periappendicular abscess and acute diverticulitis. This success has prompted the researchers to consider the exclusive use of antibiotic therapy in the treatment of non complicated appendicitis.
In patients with clinical suspicion of acute appendicitis (localized abdominal tenderness, inflammatory reaction...etc) a CT scan will be performed to confirm the diagnosis of non complicated appendicitis. This diagnosis is confirmed on the CT in the absence of any sign of either localized peritonitis, and/or perforation (extraluminal gas, appendicular abscess, or phlegmon).
After a thorough explanation of this study, the patient will be obliged to sign a written consent. Patients will be randomly assigned to either one of the two therapeutic modalities : an appendectomy,or an antibiotic treatment consisting of amoxicillin and clavulanate potassium.
This therapy will be continued until the normalisation of leucocytic count and C reactive protein are achieved. In order to demonstrate equivalent conclusive results comparing the two treatment modalities, the statistical consultant estimated the inclusion of at least 200 patients in the study. However, after considering the possible loss of a number of patients following their inclusion for a variety of reasons, it was decided that a total of 250 patients will be enrolled.
Rate of intra abdominal infections in both therapeutic strategies is the first endpoint to be compared. Duration of pain, diet, hospitalisation, absence from work will also be compared. In the group of patients treated by antibiotics, the rate of persistant and recurrent appendicitis after treatment will be evaluated. Recurrent appendicitis is not considered a complication as long as the recurrence of the appendicitis is uncomplicated. During the followup period of one year, long-term complications will be observed including: abdominal hernia, adhesive intestinal occlusion, and others.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
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Clamart, France, 92141 cedex
- Antoine Béclère Hospital - Department of Surgery
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Creteil, France, 94
- Henri Mondor Hospital
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Paris, France, 75004
- Hotel Dieu Hospital, Department of Digestive Surgery
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Paris, France, 75014
- Cochin Hospital, Department of Digestive Surgery
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Paris, France, 75475
- Lariboisière Hospital, Department of Digestive Surgery
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Before CT scanning
Inclusion Criteria:
- Clinical suspicion of appendicitis
- Age more than 18 years
Exclusion Criteria:
- Clinical signs of generalized peritonitis
- Previous take of antibiotics within the 5 days preceding the presentation
- Allergy or intolerance to lactamases and/or clavulanate potassium
- Corticosteroid or anticoagulant therapy
- Patient with a known inflammatory bowel disease (Crohn's disease or ulcerative colitis)
- Pregnant women
- Patient with iode allergy
- Renal insufficiency (creatinine > 200 )
CT scanning:
Inclusion Criteria:
- Appendix diameter > 6 mm
Exclusion Criteria:
- Appendix non visualised
Signs of localized peritonitis:
- extradigestive gas
- fluid collection around the appendix
- generalized intraperitoneal fluid
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: A
appendectomy, actual usual treatment
|
ablation of the appendix by laparotomy or laparoscopy
|
Active Comparator: B
antibiotic therapy
|
1 gramme, 3 times a day, intra venous initially and then orally for one or two weeks
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
rate of intra abdominal infections in both therapeutic strategies
Time Frame: 30 days
|
30 days
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
duration of pain
Time Frame: 30 days
|
30 days
|
duration of hospitalisation
Time Frame: 30 days
|
30 days
|
duration of absence from work
Time Frame: 30 days
|
30 days
|
rate of wound infection
Time Frame: 30 days
|
30 days
|
recurrence of appendicitis
Time Frame: 12 months
|
12 months
|
rate of abdominal hernia
Time Frame: 12 months
|
12 months
|
rate of adhesive intestinal occlusion
Time Frame: 12 months
|
12 months
|
cost
Time Frame: 30 days and 12 months
|
30 days and 12 months
|
Collaborators and Investigators
Investigators
- Principal Investigator: Corinne Vons, MD,PhD, Assistance Publique - Hôpitaux de Paris
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Infections
- Gastrointestinal Diseases
- Gastroenteritis
- Intestinal Diseases
- Cecal Diseases
- Intraabdominal Infections
- Appendicitis
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Enzyme Inhibitors
- Anti-Bacterial Agents
- beta-Lactamase Inhibitors
- Amoxicillin
- Clavulanic Acid
- Clavulanic Acids
- Amoxicillin-Potassium Clavulanate Combination
Other Study ID Numbers
- P020915
- AOR 02063
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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