Appendicitis: Is surgery always needed?

Photo of a girl holding her belly in pain

Appendicitis is usually treated with surgery to remove the appendix. Treatment with is sometimes also a suitable alternative, for example if the is uncomplicated.

Removing the appendix is a routine procedure that reliably treats the appendicitis and only rarely leads to severe complications. Appendicitis can sometimes be treated with only, though. The medication is usually given through a drip for one to three days, and then taken as a tablet or syrup for about a week after that.

How effective is treatment with antibiotics only?

Several studies have compared the effectiveness of treatment with surgery and treatment with in adults and children. The study participants had uncomplicated appendicitis. In other words, only their appendix was affected, and it was only inflamed. There were no abscesses (pockets of pus) and there were no signs that the inflammation had spread to the abdomen.

The studies have shown the following:

  • The problems went away for good in about 60 out of 100 people. They were then able to do without surgery.
  • The didn't go away, or it came back later, in about 40 out of 100 people who were treated only with . They needed surgery.

That means that the appendicitis went away in most people after being treated with only, but also that it often came back.

The appendicitis does not come back after surgery because the appendix has then been removed.

What side effects can antibiotics have?

Antibiotics can have various side effects. They often cause nausea or diarrhea, for instance. The exact side effects will depend on the specific product you are using.

Is treatment with antibiotics riskier?

The studies also compared how often complications occurred with each of the two treatments). The results were not clear: Some studies found that the treatments were about as safe as each other. Other studies found that people who only took even had fewer complications than those who had surgery (perhaps because no anesthetics or cuts were needed). But treatment with was less effective than surgery, and it carries an increased risk of getting appendicitis again – and then perhaps needing surgery after all.

Who can have treatment with antibiotics only?

Having without surgery is mainly an option for people who have uncomplicated appendicitis – that is, when there are no signs that a pocket of pus has formed or that the is spreading. It may be especially suitable for younger people who have stable health and do not have a weakened . Children who have appendicitis that is clearly uncomplicated are also first given only.

To better rule out complicated cases, examinations are often needed – for instance, a CT scan of the abdomen. But because are less likely to be effective over the long term, surgery is also often used to treat uncomplicated appendicitis.

Even if pockets of pus have already formed, can be used as treatment and surgery is not done at first. Then a thin tube has to be inserted into the abdomen to allow the pus to drain.

Some studies have looked into whether also help in people who have complicated appendicitis. They found that surgery was the more effective and safer treatment option in children whose appendix had already burst open. Surgery was also more effective over the long term in adults. So surgery within a short time is recommended for treating complicated appendicitis.

When are antibiotics alone not recommended as treatment?

Some people with uncomplicated appendicitis also have a higher risk of not being effective against the . They include:

  • People over the age of 65 years,
  • People with a weakened (immunodeficiency)
  • People who are very overweight
  • People who have had a fecalith (stone made of feces) found in their bowel
  • Pregnant women

Experts recommend that they have surgery instead, ideally within twelve hours of appendicitis being diagnosed.

Surgery needs to be performed quickly if there are signs that the is spreading.

Andric M, Kalff JC, Schwenk W et al. Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen (S1-Leitlinie). AWMF-Registernr.: 088-011. 2021.

Di Saverio S, Podda M, De Simone B et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg 2020; 15(1): 27.

Fugazzola P, Coccolini F, Tomasoni M et al. Early appendectomy vs. conservative management in complicated acute appendicitis in children: A meta-analysis. J Pediatr Surg 2019; 54(11): 2234-2241.

Herrod PJ, Kwok AT, Lobo DN. Randomized clinical trials comparing antibiotic therapy with appendicectomy for uncomplicated acute appendicitis: meta-analysis. BJS Open 2022; 6(4): zrac100.

Jaschinski T, Mosch CG, Eikermann M et al. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2018; (11): CD001546.

Poprom N, Numthavaj P, Wilasrusmee C et al. The efficacy of antibiotic treatment versus surgical treatment of uncomplicated acute appendicitis: Systematic review and network meta-analysis of randomized controlled trial. Am J Surg 2019; 218(1): 192-200.

Prechal D, Damirov F, Grilli M et al. Antibiotic therapy for acute uncomplicated appendicitis: a systematic review and meta-analysis. Int J Colorectal Dis 2019; 34(6): 963-971.

Talan DA, Di Saverio S. Treatment of Acute Uncomplicated Appendicitis. N Engl J Med 2021; 385(12): 1116-1123.

Téoule P, Laffolie J, Rolle U et al. Acute Appendicitis in Childhood and Adulthood. Dtsch Arztebl Int 2020; 117(45): 764-774.

Yang Z, Sun F, Ai S et al. Meta-analysis of studies comparing conservative treatment with antibiotics and appendectomy for acute appendicitis in the adult. BMC Surg 2019; 19(1): 110.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on February 5, 2024

Next planned update: 2027


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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