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 or another medical problem means surgery isn't possible.

Removing the appendix is a routine procedure that reliably treats the appendicitis and only rarely leads to severe complications. Uncomplicated appendicitis is sometimes 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 the inflammation had not spread to the membrane lining the space inside the abdomen (belly). The risk of the spreading in the abdomen is low.

The studies found the following: In about 20 percent of the people who only received , the didn't go away or it came back later. In other words, treatment with can help most people with appendicitis, but surgery is more likely to be effective overall.

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 only an option for people with uncomplicated appendicitis. To better rule out complicated cases, other 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 the standard treatment for uncomplicated appendicitis.

Treatment with alone is suitable if there are reasons not to have surgery, though. For instance, because somebody has another medical problem that increases their risk of complications due to the anesthetic or surgery, or because they don't want to have surgery. Children with clearly uncomplicated appendicitis are sometimes only given at first, too.

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.

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.

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.

Teoule 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. informedhealth.org 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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Created on June 23, 2022
Next planned update: 2025

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

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