Classic Paper: Antibiotics for Appendicitis

Do we really need surgery for all appendicitis? Mel discusses a classic paper that investigates a subset of patients that can be treated non-operatively. 

janardan T. -

What type of patients are treated with antibiotics and are they send home with 24 hour follow up or admitted to the hospital with IV and NPO, if admitted is the patient is admitted to medical or surgical floors.
This is easy for surgical resident to wah there hands, the resident should come and see the patient and decided about disposition with consultation with surgeon on call.

Mel H. -

This is still early days. In general they have to look well, have no perforation or abscess formation. They are often given amoxicillin clavulanate orally. In some studies they where given an initial IV dose of a broad spectrum antibiotic. In the studies they where seen with surgery as part of the protocol. In the real world I think the key is the gather the players (surgery, EM, primary care) and decide on a local protocol. Some will always want surgery to see the patients initially, others will be comfortable with primary care follow-up. Failure rates are pretty high over time, so surgery might be required in 30% or more. So I think the key is local protocols that everyone agrees with and very good return precautions if they don't get better.

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