Muristek
In Reply We agree with Dr Talan that goals of treatment and individual preferences are decisive factors that will guide modern care of acute appendicitis. However, for appendicitis treated with antibiotics, we would like to clarify the meaning of treatment failure, which is scientific terminology describing lack of symptom improvement within 24 to 48 hours after initiation of antibiotics. In our Review, we based our recommendations for the management of acute uncomplicated appendicitis on a critical evaluation of currently available data about the potential of success of each treatment modality. That said, patients with appendicoliths and signs of systemic inflammatory response (such as high fever and leukocytosis) may choose to pursue antibiotic treatment and accept the chance of a higher “failure” rate, hoping to achieve the other benefits of nonoperative therapy noted by Talan. We believe that the management of acute appendicitis is changing. Now, patients have a reasonable therapeutic option other than surgery that should be presented to them in detail. For patients who want a choice, our responsibility is to adequately inform them of the long-term outcome of the antibiotics-first approach to appendicitis before proceeding with nonoperative therapy, especially since long-term data have shown that almost 50% of patients initially treated with antibiotics alone for acute appendicitis require appendectomy within 3 to 4 years.
Most Read