Appendicitis: Surgery Isn't Always Necessary

New Treatment Regimen Means Medication is an Option

Abdominal Pain Is Often the First Sign of Appendicitis.

Since 1889, the gold standard of treatment for appendicitis has been surgical removal of the appendix.  That was the year that surgeons were able to surgically intervene rather than watching helplessly as a patient died of appendicitis.  Since that time, the result of not having surgery was expected to be death from a perforated appendix and the resulting widespread infection. 

In recent years, a new approach to appendicitis has been utilized: antibiotics.

  For some, treatment with antibiotics has meant that surgery was not necessary for a complete recovery.    

Who is a Candidate For Antibiotic Treatment of Appendicitis?

Uncomplicated acute appendicitis, which means the appendix is intact and has not ruptured, has been successfully treated with antibiotics.  Complicated appendicitis, meaning the appendix has ruptured and has begun to leak infection into the abdominal cavity, should still be treated surgically as the infection has spread beyond the appendix.  

Is This a New Treatment?

Using antibiotics in the treatment of appendicitis is not new; however, it was not done with the intention of replacing surgery.  In some cases it was done as a “bridge” to surgery, meaning the patient was treated with antibiotics until surgery could be done.  For other patients, who were suspected of having appendicitis but could not be clearly diagnosed, antibiotics were also used as a treatment.


A lack of research into whether antibiotics could be used successfully in lieu of surgery played a role in keeping antibiotics from becoming a successful treatment plan for many years.  Fear of complications often led patients to elect surgical treatment because it has always been treated in that fashion during their lifetime.

Can I Choose Surgery For My Appendicitis?

Surgery is absolutely a reasonable option for the treatment of appendicitis.  Minimally invasive techniques have made the surgery safer, with a reduced healing time from the days of the large incision.  In rare circumstances the “open” technique with a three to five inch incision may be used, but for most patients the laparoscopic method is appropriate and uses several small incisions, one of which is typically hidden in the folds of the belly button.

Is The Antibiotic Approach to Appendicitis Safe?

New research shows that the antibiotic approach is safe.  Remember that you can always elect to have surgery, and if antibiotics are not successful, an appendectomy would be the obvious treatment choice.  

One large study looked at about nine hundred patients with appendicitis and divided them into two groups, those treated with antibiotics and those treated with surgery.  Of the 438 patients treated with antibiotics, 345 were treated successfully and did not need appendix surgery.

  In the following year, 68 of the successfully treated patients returned to the hospital with a diagnosis of appendicitis.  Also of note is that the non-surgical patients had a 31% risk reduction by avoiding surgery.  

After examining the records of all of the appendicitis patients, the study concluded that appendicitis treatment with antibiotics is both safe and effective.  

Expect to see more studies that look at the safety and effectiveness of treating appendicitis with antibiotics as this treatment approach becomes more common, and it would also be expected that outcomes would improve as research provides more insight into the best treatment regimens.

How Do I Choose Antibiotics or Appendectomy?

Your surgeon and the tests performed at the hospital will play a major role in the decision to use antibiotics or surgery for your treatment.  Early appendicitis, meaning the symptoms have not been present for an extended period of time, responds best to this approach.  If you have been experiencing abdominal pain for several days, you may not be a good candidate for antibiotics.  Talk to your surgeon, discuss your options and concerns, and make the best possible decision for your unique situation.

Expect large, university based research oriented hospitals to be more likely to offer antibiotic treatment, as this is a relatively new approach.  If studies continue to show that this type of treatment is safe and effective, it will become more common in all hospitals over time. 

Will I Still Get Antibiotics if I Have Surgery?

Absolutely.  Antibiotics are a normal standard of care after having an appendectomy. Your choice to choose antibiotic treatment or surgical treatment will not affect the care you receive after having surgery.  Before your appendectomy, your surgeon will discuss the risks of surgery, what you can expect during your recovery and how long your recovery will likely take. 


Appendicitis Treatment and Management. Medscape. Accessed April, 2015.

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