In some cases, doctors will treat appendicitis with antibiotics, but the infection needs to be mild and uncomplicated (meaning the appendix hasn’t perforated and the infection hasn’t spread).
Appendicitis is usually considered a medical emergency, and doctors treat the condition with an appendectomy, the surgical removal of the appendix.
Surgeons will remove the appendix using one of two methods: open or laparoscopic surgery.
An open appendectomy (laparotomy) requires a single incision in the appendix region, the lower right area of the abdomen.
During laparoscopic surgery, on the other hand, surgeons insert special surgical tools into several smaller incisions. This option is believed to have fewer complications and a shorter recovery time. (12)
If a person’s appendix isn’t treated in time, it may burst and spread the infection throughout the abdomen, leading to a life-threatening condition called peritonitis, an inflammation and infection of the peritoneum (the lining of the abdominal cavity). Symptoms of peritonitis include fever, nausea, vomiting, bloating, and severe tenderness in the abdomen. (1) Peritonitis is usually treated with antibiotics, and surgery is often necessary to remove the infected tissue and prevent the infection from spreading. (20)
In other cases of complicated appendicitis, abscesses may form on or around the burst appendix. In both these cases, surgeons will usually drain the abdomen or abscess of pus and treat the infection with antibiotics before removing the appendix.
Antibiotics are used before and after an appendectomy to prevent wound infections.
Doctors might do what’s known as an “interval appendectomy” if a patient has a ruptured appendix: antibiotics are administered first, and once they successfully clear the infection, an appendectomy is performed several weeks later. (12)
Because there’s no perfect test to confirm appendicitis, and other illnesses can cause symptoms similar to those of appendicitis, your doctor might find during appendectomy surgery that the appendix is not actually infected. According to the NIH, this can happen up to 25 percent of the time. If this occurs, your surgeon will often still remove the appendix as a prophylactic measure. (10)
Chronic vs. Acute Appendicitis
Acute appendicitis happens quickly and needs to be treated urgently. But in some cases, the symptoms caused by inflammation of the appendix — especially pain in the lower right abdomen — can last for weeks, months, or even years, subsiding on their own and then later recurring. This is called chronic appendicitis, and it accounts for approximately 1.5 percent of all appendicitis cases. (10)
Chronic appendicitis may be misdiagnosed because the symptoms can mimic those of other conditions, such as Crohn’s disease or pelvic inflammatory disease. Once chronic appendicitis is properly diagnosed, an appendectomy resolves symptoms for most patients. (21)
Learn More About Chronic Appendicitis
Antibiotics as a Treatment for Appendicitis
In the last few years, research has suggested that uncomplicated appendicitis — appendicitis without a ruptured appendix, pus-filled abscesses, or peritonitis — can be treated with antibiotics alone. This approach has advantages: Patients whose appendicitis is treated with antibiotics instead of an appendectomy require less pain medication and have fewer complications. It’s also less expensive. (22)
Still, whether antibiotics-only should become the first-line treatment for cases of uncomplicated appendicitis is up for discussion. It can be hard to distinguish complicated appendicitis from uncomplicated; sometimes the complexity can’t be determined until the operation. And there’s a higher chance of recurrence with antibiotics-only treatment: In a study published in 2015, among patients with uncomplicated appendicitis treated only with antibiotics, 27 percent required surgical intervention within a year. (23)
A 2022 review found that the percentage of children with uncomplicated appendicitis that is medically managed instead of having surgery has risen over the past decade and now hovers around 30 percent. The use of what the researchers called nonoperative management (NOM) was mostly successful, with only 20 percent of cases resulting in a subsequent occurrence of complicated appendicitis and necessary surgery. The vast majority of these cases of NOM failure happened within two weeks of the patients’ initial appendicitis. However, it’s important to note that those whose appendicitis was treated with NOM and who later needed surgery were at higher risk of postoperative complications compared to those who were immediately treated with surgery. (24)
The guidelines are changing for adults and children for uncomplicated acute appendicitis, so it’s best to have a discussion with your medical and surgical team about the risks and benefits of comparing a surgical and antibiotic-first strategy for your specific medical situation. (25)
Learn More About Antibiotics and Appendicitis
Prevention of Appendicitis
There is no known way to prevent appendicitis. There is very limited research showing a possible relationship between a low-fiber diet and risk of appendicitis, but more research is needed. (26)
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