We read with interest the article by Abou-Nukta et al1 on the effect of delayed source control in the treatment of uncomplicated and complicated acute appendicitis. The authors concluded that delaying the surgical intervention for 12 to 24 hours did not affect outcome in 309 patients treated at their institution.
Although timely source control is considered the cornerstone of the treatment of surgical infections,2 the role of antibiotics is also important. Previous reports have shown that antibiotics alone can successfully be used to treat perforated and nonperforated appendicitis.3,4 Obviously, also after a surgical source-control procedure, antibiotics can be indicated. Although there is a consensus that antibiotic treatment is not indicated in patients with nonperforated appendicitis, antibiotics are continued in the postoperative course in patients with complicated appendicitis to prevent local recurrence and systemic complications.5,6
De Waele JJ, Blot S. Antibiotic Use and Delayed Source Control in Acute Appendicitis. Arch Surg. 2007;142(1):99-100. doi:10.1001/archsurg.142.1.99-b