“Appendectomy has long been the standard treatment for appendicitis, even though successful use of antibiotic therapy as an alternative was reported more than 60 years ago. Although there have been several randomized trials of antibiotics for appendicitis
in adults, exclusion of important subgroups (in particular, patients with an appendicolith, who
may be at an increased risk for complications), small sample sizes, and questions about applicability to the general population have limited the use of this treatment. As recently as 2014, more than 95% of U.S. patients with appendicitis underwent appendectomy. However, with the pandemic of coronavirus disease 2019 (Covid-19), health systems and professional societies such as the American College of Surgeons have suggested reconsideration of many aspects of care delivery, including the role of antibiotics in the treatment of appendicitis.”

“This comparative effectiveness trial showed that, for the treatment of appendicitis, antibiotics were noninferior to appendectomy on the basis of results of a standardized measure of general health status, at least in the short term. In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days, and there were more emergency department visits and hospitalizations after the index treatment than in the appendectomy group. An alternative perspective is that, in the antibiotics group, more than
7 in 10 participants avoided surgery, many were treated on an outpatient basis, and participants and caregivers missed less time at work than with appendectomy. In the antibiotics group, participants with an appendicolith were at a higher risk for both appendectomy and complications than participants without an appendicolith. These data may be particularly relevant during the Covid-19 pandemic, as patients and clinicians weigh the benefits and risks of each approach, considering individual characteristics, preferences, and circumstances.”

CODA Collaborative et al. “A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis.” The New England journal of medicine vol. 383,20 (2020): 1907-1919.