#EMconf: Scalpel vs Antibiotics for Appendicitis

Acute Appendicitis Management – Are we ready to start treating with antibiotics?

There are multiple studies comparing antibiotic therapy vs surgery for acute appendicitis, including two RCTs on the topic:

When treated with antibiotics alone:

  • 80-90% were successfully treated 
  • Approximately 10% of patients progressed to requiring surgery within the first 1-1.5 days 
  • About 14% had recurrence of symptoms after discharge

In Summary:

  • Acute, non-perforated appendicitis can be treated successfully with antibiotics.  
  • However, there is a risk of recurrence in cases and this risk should be weighed with the risk of complications after appendectomy
  • Antibiotic treatment appears to be a safe first-line alternative therapy in unselected patients with acute appendicitis


Styrud, J., Eriksson, S., Nilsson, I. et al. Appendectomy versus Antibiotic Treatment in Acute Appendicitis. A Prospective Multicenter Randomized Controlled Trial. World J. Surg. (2006) 30: 1033

Hansson J, Korner U, Khorram-Manesh A, Solberg A, Lundholm K Randomized clinical trial of antibiotic therapy versus appendectomy as primary treatment of acute appendicitis in unselected patients. 2009. British Journal of Surgery, 96: 473-481. DOI: 10.1002/bjs.6482