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The results of this study support the conservative management of acutely ill patients with the clinical diagnosis of perforating appendicitis. An interval appendectomy should be performed four to six weeks later. If the patient does not respond after a clinical trial of 12 to 24 hours, there is no increased morbidity from performing an appendectomy at that time. Selection of antibiotic therapy should be appropriate to cover the usual intestinal flora of aerobes and anaerobes. Ampicillin, gentamycin or tobramycin, and clindamycin currently are the recommended antibiotics at this institution. The patient is seen in the office each week until interval appendectomy is performed. Any recurrence of fever or abdominal pain warrants immediate hospital admission and appendectomy. This approach in selected patients had proved safe when adequate follow-up study is assured.