MONTREAL — Antibiotic therapy is largely successful for treating acute, nonperforated appendicitis, but unlike surgery, it carries a risk of recurrence, according to long-term follow-up on the first randomized comparison of both treatments, Dr. Staffan Eriksson said at a meeting sponsored by the International Society of Surgery.
“This is a treatment with quite a high number of recurrences, but the treatment may have some advantages. It can be used in patients who do not want surgery, or in patients who are not fit for surgery,” said Dr. Eriksson of Uppsala (Sweden) University. It might also be useful for postponing night surgery until the next day, as has been shown in children, he said.
The multicenter study randomized 252 men, aged 15–50 years, from six Swedish centers, to surgery (124 patients) or antibiotic therapy (128 patients). Excluded from the study were patients in whom there was a high suspicion of perforation.
Patients in the antibiotic group received 2 days of intravenous therapy consisting of cefotaxime 2 g twice daily and tinidazole 0.8 g once daily. This was followed by 10 days of oral antibiotic therapy consisting of ofloxacin 0.2 g twice daily and tinidazole 0.5 g twice daily, he said.
In the surgery group, there was a 5% perforation rate and a 14% complication rate, mainly from wound infection.
The same rate of perforation was noted in the antibiotic group, in which 15 patients were treated surgically, 7 of whom had perforations. The remainder of patients in the antibiotic group (88%) recovered without surgery, said Dr. Eriksson. However, there was a 24% rate of recurrence within the 5-year follow-up.