Can You Treat Appendicitis With Antibiotics?

When it comes to treating appendicitis, you might be surprised to find that surgery isn’t your only option. In some cases, antibiotics can also help with healing.

Your appendix is a small pouch connected to your large intestine that can become inflamed and filled with bacteria. If you don’t seek prompt treatment for appendicitis, your appendix can rupture, releasing bacteria into the rest of your abdomen and leading to a potentially life-threatening infection.

Here’s what you should know about using antibiotics or surgery to treat appendicitis.

“Appendicitis doesn't go from early, acute appendicitis to ‘bursting’ in a matter of a few moments,” says Tracey Childs, MD, who is board-certified in general and colorectal surgery and chief of surgery at Providence Saint John’s Health Center in Santa Monica, California.

Dr. Childs adds that the complexity of your condition can influence what kind of appendicitis treatment you need. While surgery may still be best for most children with appendicitis, people with pre-existing conditions like cardiac or pulmonary concerns may find that antibiotics could suffice, she says.

“There is increasing evidence that some people may be managed with antibiotics alone,” says Jonathan Jennings, MD, a board-certified internist with Medical Offices of Manhattan in New York.

Dr. Jennings says people with chronic conditions like diabetes or heart, liver, or kidney disease, as well as people with multiple conditions or advanced age, have a higher risk of developing complications from surgery. In these cases, non-surgical options like antibiotics could be the safer route.

Which Antibiotics Can Treat Appendicitis?

• ampicillin and sulbactam (Unasyn)
• cefepime (Maxipime)
• cefotetan (Cefotan)
• cefoxitin (Mefoxin)
• ertapenem (Invanz)
• gentamicin (Garamycin)
• levofloxacin (Levaquin)
• meropenem (Merrem)
• metronidazole (Flagyl)
• piperacillin and tazobactam sodium (Zosyn)

If your appendix is ruptured, doctors may also use an intravenous (IV) antibiotic to treat abdominal infection such as peritonitis — a serious infection of the peritoneum membrane that lines your abdominal cavity — after removing your appendix.

Risks of Treating Appendicitis With Antibiotics

Avoiding surgery sounds appealing, but antibiotic-only treatment does come with some risks. Antibiotic side effects and overnight hospital stays for IV antibiotics are some things to keep in mind, says Childs.

Antibiotics could successfully treat uncomplicated acute appendicitis — as in, appendicitis without a ruptured appendix, pus-filled abscesses, or peritonitis — around 80 to 90 percent of the time, says Shelby Reiter, MD, general surgeon for Swedish Surgical Specialists in Edmonds, Washington.

Dr. Reiter adds that studies have also shown that about 30 to 40 percent of these patients could develop recurring appendicitis and end up undergoing appendectomy within the next five years.

Appendectomy is the surgical procedure to remove the appendix. While surgery can sound scary, doctors often perform minimally invasive procedures called laparoscopic appendectomies, allowing you to leave the hospital one or two days after the procedure.

A laparoscopic appendectomy can sometimes be an outpatient procedure, allowing you to return home on the same day.

“The vast majority of appendicitis in the United States is treated with minimally invasive appendectomy, often with less than one day hospital stay,” says Childs. Most people can go back to their usual activities, including work, fairly quickly, she says.

“Both surgery and antibiotics alone are generally safe options, but each case varies, so it’s best to have a discussion about all of these considerations with your medical team,” says Reiter.

Childs highlights that the literature suggests people under age 18 or over the age of 60 should receive surgery. “However, if there are no other contraindicating factors, consideration could be made for antibiotics,” she says.

Because appendicitis is often a rapidly progressing condition, early diagnosis and having a low threshold for evaluation is key in getting people the care they need, says Jennings.

It’s also important to keep a lookout for recurring symptoms if you previously took antibiotics for appendicitis. When opting for antibiotics over surgery, you run the risk of symptoms like pain, nausea, or vomiting, as well as the infection itself not improving or even worsening, says Childs.

“If someone is risk-averse and wants to completely eliminate the possibility of progressing to complicated or perforated appendicitis or recurrence, then early surgery is the best choice,” Childs adds.

• Your appendicitis treatment options, including surgery and antibiotics, can vary based on age, medical history, and medical conditions.
• While antibiotics can treat some cases of uncomplicated appendicitis, surgery is often the first-line treatment.
• Appendectomy, the surgery to remove your appendix, is often a minimally invasive procedure that allows most people to return to their daily lives relatively quickly.