Question special
Chief Resident

1) I think the antibiotic regimen for those in the antibiotic only arm was not specified for the partner sites in the protocol, is that correct? Was this perhaps because it is difficult to standardize an antibiotic regimen across many sites? And, maybe similarly, it's hard to require sites to hospitalize these patients for a set period of time. I wonder if antibiotic only arm patients were required to be hospitalized for 24 hours, if that would have changed their need for appy or having complications, maybe if their clinical course was observed? But then again, it seemed that the LOS between the arms wasn't terribly different.
2) Treatment response to antibx at 10 days was clinically defined as resolution of symptoms (fever, abd pain, tenderness to palpation), correct? 11% of that group required 2nd course of antibx. Was it built into the protocol to always do trial of 2nd course of antibx, instead of crossover into appy directly? Or were there certain criteria that would warrant crossover after 1st antibx treatment failure.
As internists that would help take care of these patients potentially, we think about antibx stewardship and untoward effects of multiple courses of antibiotics, and so I wonder how this subset of antibx only arm that had 2 courses of antibx did with regards to outcomes, complications, and adverse effects. Thank you!