2019 Volume 39 Issue 4 Pages 637-644
As simple appendicitis not effectively addressed with antibiotics can progress to complicated appendicitis, repeated monitoring of the effect of selected antibiotics is important to prevent treatment failure. We retrospectively examined complications after antibiotics-first treatment while focusing on two effective clinical indicators targeting disseminated peritonitis and reduction in white blood cell (WBC) counts. Receiver operating characteristic curve analysis of 50 cases established the effective cut-off value of WBC counts at 80％. Antibiotic therapy was initiated with careful management of daily WBC counts; antibiotics were changed if there was no response. Patients in whom the therapy failed were treated with surgery within 48 hours. Seventy-two patients were treated via this management strategy. Emergency surgery was performed in 26 patients. For 46 patients, antibiotics-first therapy was initiated; 8 patients required a change of antibiotics. The 46 antibiotics-first patients did not require surgery. No complications were seen in any of the patients. Based on our results, these two indicators, clinical examination and 80％ cut-off for decreasing the WBC values within 24 hours, could be effective to treat simple appendicitis.
