Dr. Abhijit Pathak, professor of surgery at the Lewis Katz School of Medicine at Temple University in Philadelphia and Medical Director of the Surgical Intensive Care Unit at Temple University Hospital, noted, “It is unclear what criteria constituted a treatment failure (or antibiotic nonresponsiveness) and there are a small number of patients who were deemed to be nonresponders, so interpretation of the factors constituting failure are difficult to determine, although it seems plausible that a dilated appendix (>15mm) and high fevers would be risk factors for failure.”

“There is no clear consensus yet on the optimum management of adult patients with acute uncomplicated appendicitis,” he noted. “The Eastern Association for the Surgery of Trauma could not make a recommendation for or against antibiotics-first therapy versus surgery (https://bit.ly/3p3Zh4e). The World Society of Emergency Surgery in their 2020 update (https://bit.ly/3mNbVBy) recommends a discussion with the patient… advising of the possibility of failure and the misdiagnosis of complicated appendicitis.”

Dr. Lindsay Hessler of The Center for Minimally Invasive Surgery at Mercy Medical Center in Baltimore, Maryland, commented, “It is hard to say if these findings are consistent with what I see in practice, since the normal recommendation for a patient in the U.S. is still to perform an appendectomy.”

“I think that any ‘culture change’ can be difficult,” she said. “There are many studies – some good, some not as good – about antibiotics and nonoperative management of uncomplicated appendicitis. However, the topic remains controversial. Time will tell if these results make their way into general practice.”