In a prospective controlled study the effect of antibiotics as the only treatment in acute appendicitis was evaluated. Of 40 patients admitted with a duration of abdominal pain of less than 72 h, 20 received antibiotics intravenously for 2 days followed by oral treatment for 8 days and 20 considered as controls were randomized to surgery. All patients treated conservatively were discharged within 2 days, except one who required surgery after 12 h because of peritonitis secondary to perforated appendicitis. Seven patients were readmitted within 1 year as a result of recurrent appendicitis and underwent surgery, when appendicitis was confirmed. The diagnostic accuracy within the operated group was 85 per cent. One patient had perforated appendicitis at operation. Antibiotic treatment in patients with acute appendicitis was as effective as surgery. The patients had less pain and required less analgesia, but the recurrence rate was high.
Over 100 years have passed since McBurney' reported his study of eight patients with acute appendicitis with special reference to early appendicectomy.
The idea of conservative treatment with antibiotics is not novel and Coldrey2 in 1959 treated 471 unselected patients conservatively, with low mortality and morbidity rates. His idea was as controversial then as it is today. Of 500 patients with suspected acute appendicitis 425 were treated conservatively, with use of traditional Chinese medicines and antibiotics in some3. Only seven of 100 patients at follow-up had recurrent appendicitis. In both studies patients were assessed by history and clinical examination, the treatment differed without standardization and there was no consecutive follow-up. A recent study4 of 695 children has demonstrated that the administration of preoperative antibiotic treatment can be used as a means of delaying appendicectomy, particularly during twilight hours. The incidence of perforation, complications and hospitalization in children operated on within 6 h was the same as that of those undergoing operation between 6 and 18 h after admission4.
The appendiceal mass can be treated successfully by conservative but some recommend interval appendicect~my~.~ in case there is a caecal neoplasm or recurrent appendicitis supervenes.
Conservative treatment of acute appendicitis has been described in American submariners" (nine patients) and on board Soviet ships at sea (247)'*. There has been no prospective randomized trial.
The present pilot prospective randomized study compared the results of conservative treatment with antibiotics and surgery in patients with acute appendicitis.