“…A further meta-analysis 3 years later with four additional subsequent randomised controlled trials agrees with the aforementioned study, that treatment with antibiotics results in lower complication rates, and in addition, they concluded that treatment with antibiotics produced less pain and a quicker return to work (an important factor in force impact in the military deployed population.) However, with regard to treatment efficacy, treatment failure and readmissions, surgery was still considered to be the gold standard 22. This large evidence base, although may swing in favour of surgical management as the treatment of choice, still reassures the military clinician that in the event of surgery being impossible in the deployed environment, the use of antibiotics is a safe alternative, with the proviso that the patient can be monitored for potential failure of treatment, and may even carry the benefit of a quicker return to duties if successful.…”