Will You Choose Antibiotics for Appendicitis?

Appendicitis, an acute inflammation of the appendix, is a surprisingly common problem, affecting an estimated 7 to 8 percent of people over their lifetimes. For hundreds of years, the only treatment for uncomplicated, acute appendicitis was emergency abdominal surgery. (Here’s a link to that history.) For the last four decades, laparoscopic surgery has been the treatment of choice. It leads to less postoperative pain and faster recovery times. Over the last several years, though, doctors have wondered whether infection and inflammation in the appendix might be treated with antibiotics instead.

Clinical Trials of Antibiotics for Appendicitis:

In 2015, scientists published a randomized clinical trial comparing surgery to antibiotic treatment. A large majority of patients who got antibiotics did not require surgery for a recurrence of appendicitis within one to two years after treatment. That study included 273 people undergoing surgery and 257 taking antibiotics. Because the study was initiated so long ago, the surgery was an open appendectomy rather than laparoscopic. That meant those getting surgery needed a longer time to recover than they would if the comparison were started today.

Over the years, some of those who were initially treated with antibiotics required surgery. Five-year follow-up showed that 39 percent who got antibiotics later required surgery. Now the same scientists are reporting the results of ten years of follow-up (JAMA, Jan. 21, 2026). They were able to check in with 253 of the original 257 patients. More than half of them did not require surgery.

The researchers conclude:

“Among patients initially treated with antibiotics for uncomplicated acute appendicitis, the rate of recurrence and appendectomy at 10-year follow-up supports the use of antibiotics as an option for uncomplicated acute appendicitis in adult patients.”

Other clinical trials reinforce the idea that doctors could treat uncomplicated appendicitis with antibiotics. A review of these studies suggests that about 70 percent of people with appendicitis respond well to broad-spectrum antibiotics (JAMA, Dec. 14, 2021). People with an enlarged appendix or a calcified deposit (appendicolith) may well need surgery instead.

Can Doctors Use Antibiotics for Appendicitis?

Previously, a large, randomized clinical trial published in The New England Journal of Medicine compared the outcomes of antibiotics with appendectomy (NEJM, Oct. 5, 2020). The trial included 1552 adults with appendicitis in 25 different medical centers in the US. Researchers randomly assigned these patients to undergo surgery or take a 10-day course of antibiotics. They followed up on the outcomes for three months.

What Did the Study Find?

Ninety-six percent of those assigned to appendectomy had a laparoscopic procedure, which usually permits faster recovery. Not everyone who took antibiotics avoided surgery completely. Within three months, 29 percent of those taking antibiotics required surgery. Nonetheless, 71 percent of the patients receiving antibiotics did not need follow-up surgery for at least three months. People who took antibiotics were more likely to experience a complication than those who went through surgery. However, most of the people experiencing post-antibiotic problems had an “appendicolith,” a calcified deposit within the appendix. When doctors find an appendicolith, they often expect the the treatment of appendicitis to be clinically complicated (International Journal of Colorectal Disease, Aug. 2019).

What Is the Take-Away?

Patients who would prefer to stay out of the hospital may welcome the option of taking antibiotics for appendicitis. They might wish to ask whether the CT scan used for the diagnosis reveals an appendicolith.