Antibiotics as First-Line Therapy for Acute Appendicitis: Evidence for a Change in Clinical Practice

Excerpt

Nonoperative treatment of acute appendicitis (AA) with antibiotics is not “big news” to surgeons who follow the literature. The current discourse about nonsurgical versus surgical treatment of AA is as old as the history of appendectomy. The pioneers in surgery were aware that many instances of AA are self-limited. The problem was to identify and treat those that would progress to perforation. In time, early surgery became the standard of care, and the frequency of appendectomy increased dramatically during the first decades of the 20th century. What is less well known is that it had almost no influence on appendicitis-related mortality rates. With the advent of antibiotics during the 1940 s, some tried curing AA without an operation. George Crile, Jr. during the 1940 s, for example, treated AA successfully with high-dose penicillin in 50 U.S. soldiers [1]. In his memoir, Crile recalled that: “The surgical profession did not shout its acclaim. For surgeons appendectomy for acute appendicitis was almost a religious concept.” …