title: Conservative treatment of acute appendicitis: an overview.
abstract: BACKGROUND
  Although the standard treatment for appendicitis (since 1883) is an appendectomy, this is not always possible in a maritime or military setting. To avoid relying on improvisation in such situations this study examines the evidence for conservative management of appendicitis.
  
  
  METHODS
  PubMed was searched for studies on conservative treatment of appendicitis. Both prospective and retrospective studies with a well-defined description of the protocol were included.
  
  
  RESULTS
  Finally, 5 publications (a total of 342 patients) were included in this overview. For these reports, the success rate for conservative treatment of appendicitis is 90.8% (88-95%) with a risk of relapse within 12 months of 15.9% (5-37%). For complicated appendicitis these mean rates decrease to 89% (67-100%) and 9.8% (0-39.6%), respectively.
  
  
  CONCLUSIONS
  This overview indicates that appendicitis can be safely and effectively treated conservatively. The studies differed in their treatment protocols. Appendicitis can best be treated with a third-generation cephalosporin and an imidazole derivative (2 days intravenously and 10 days orally). This is based on evidence from a combination of the studies presented here, and on expert opinion. Currently, this combination is the best available "evidence" on this topic.
authors.affiliation: Maritime Medical Expertise Centre Royal Netherlands Navy, PO Box 10.000, 1780 CA Den Helder, The Netherlands. Binsi.w@gmail.com
authors.forename: K H
authors.initials: KH
authors.lastname: Wojciechowicz
authors.forename: H J
authors.initials: HJ
authors.lastname: Hoffkamp
authors.forename: R A
authors.initials: RA
authors.lastname: van Hulst
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001064:Appendicitis / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D008887:Military Medicine; D009326:Naval Medicine
chemical_list: D000900:Anti-Bacterial Agents