title: Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial.
abstract: BACKGROUND
  Appendectomy has been the treatment for acute appendicitis for over 120 years. Antibiotic treatment has occasionally been used in small uncontrolled studies, instead of operation, but this alternative has never before been tried in a multicenter randomized trial.
  
  
  METHODS
  Male patients, 18-50 years of age, admitted to six different hospitals in Sweden between 1996 and 1999 were enrolled in the study. No women were enrolled by decision of the local ethics committee. If appendectomy was planned, patients were asked to participate, and those who agreed were randomized either to surgery or to antibiotic therapy. Patients randomized to surgery were operated on with open surgery or laparoscopically. Those randomized to antibiotic therapy were treated intravenously for 2 days, followed by oral treatment for 10 days. If symptoms did not resolve within 24 hours, an appendectomy was performed. Participants were monitored at the end of 1 week, 6 weeks, and 1 year.
  
  
  RESULTS
  During the study period 252 men participated, 124 in the surgery group and 128 in the antibiotic group. The frequency of appendicitis was 97% in the surgery group and 5% had a perforated appendix. The complication rate was 14% in the surgery group. In the antibiotic group 86% improved without surgery; 18 patients were operated on within 24 hours, and the diagnosis of acute appendicitis was confirmed in all but one patient, and he was suffering from terminal ileitis. There were seven patients (5%) with a perforated appendix in this group. The rate of recurrence of symptoms of appendicitis among the 111 patients treated with antibiotics was 14% during the 1-year follow-up.
  
  
  CONCLUSIONS
  Acute non-perforated appendicitis can be treated successfully with antibiotics. However, there is a risk of recurrence in cases of acute appendicitis, and this risk should be compared with the risk of complications after appendectomy.
authors.affiliation: Department of Surgery, Karolinska Institutet at Danderyd Hospital, S-182 88, Stockholm, Sweden. johan.styrud@ds.se
authors.forename: Johan
authors.initials: J
authors.lastname: Styrud
authors.forename: Staffan
authors.initials: S
authors.lastname: Eriksson
authors.forename: Ingemar
authors.initials: I
authors.lastname: Nilsson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Ahlberg
authors.forename: Staffan
authors.initials: S
authors.lastname: Haapaniemi
authors.forename: Gunnar
authors.initials: G
authors.lastname: Neovius
authors.forename: Lars
authors.initials: L
authors.lastname: Rex
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Badume
authors.forename: Lars
authors.initials: L
authors.lastname: Granström
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy / Q000009:adverse effects; D001064:Appendicitis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence
chemical_list: D000900:Anti-Bacterial Agents