Table of ContentsView AllTable of ContentsAntibiotic Medication Instead of SurgeryAppendicitis Medication Combined With SurgeryAppendicitis Medication Side EffectsAntibiotic Choice
Table of ContentsView All
View All
Table of Contents
Antibiotic Medication Instead of Surgery
Appendicitis Medication Combined With Surgery
Appendicitis Medication Side Effects
Antibiotic Choice
The onset ofappendicitisis an urgent problem that needs treatment. Whether you receive surgery (anappendectomy) or not, medication will be administered during treatment.
This article describes how appendicitis medication can be taken alone or with surgery to treat a diseased appendix.
Shana Novak / Getty Images
Is There a Gold Standard for Appendicitis Treatment?Laparoscopic appendectomy is regarded as the gold standard for acuteappendicitis treatment.However, in uncomplicated cases of appendicitis, antibiotics are “an acceptable first-line treatment,” according to guidelines from the American College of Surgeons.
Is There a Gold Standard for Appendicitis Treatment?
Laparoscopic appendectomy is regarded as the gold standard for acuteappendicitis treatment.However, in uncomplicated cases of appendicitis, antibiotics are “an acceptable first-line treatment,” according to guidelines from the American College of Surgeons.
Research indicates that up to 70% of people with appendicitis may benefit from treatment withmedication instead of surgery.
Appendicitis treatment without surgery is less risky for adults with uncomplicated appendicitis, with no immediate threat of rupture or other problems. It may also benefit older people for whom surgery carries a higher risk of potential complications.
For Pain
Appendicitis symptoms of pain and infection last until the appendicitis is treated or surgically removed. If you opt fortreatment with antibiotics medication instead of surgery, you may need drugs to treat your pain until the antibiotics take effect.
Despite past concerns that the therapeutic effects ofanalgesicscan increase the risk of a diagnostic error, several randomized controlled studies have reported that treating pain with opioids or other analgesics does not affect the accuracy of a diagnosis.
The following medications may help with pain if you are taking antibiotics medication instead of undergoing surgery:
Opioidscan relieve severe pain viaintravenous (IV) therapyor oral administration. Because they are highly addictive, they are taken for limited periods to avoid developing physical dependence. The following opioids may help to relieve the pain of appendicitis:
Non-steroidal anti-inflammatory drugs (NSAIDs) have properties that can reduce pain, inflammation, and fever. They include the following medications:
Tylenol (acetaminophen) is a non-opioid pain reliever that reduces pain and fevers. Make sure not to go over the maximum dose of 3,600 milligrams a day and to take into consideration the acetaminophen in Percocet (oxycodone with acetaminophen) and Vicodin (hydrocodone with acetaminophen) in that number.
For Infection
Appendicitis occurs due to an appendix obstruction, leading to bacterial overgrowth. Antibiotics treat infections that are confined to the appendix before the appendix ruptures and then spread beyond the organ. The type of antibiotic required depends on the infection’s classification, your comorbidities, physiological conditions, and the risk of adverse outcomes.
Though there is no standardized treatment regimen, therapy usually involves 10 days of treatment that includes three to five days of IV therapy, with the remaining days completed with oral medication at home. Common antibiotics for treatment with medication instead of surgery include the following drugs:
For low-risk patients with community-acquired infections:
For high-risk patients with community-acquired or healthcare/hospital-acquired infections:
Efficacy of Antibiotic-Only Treatment of AppendicitisResults from the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) reported that antibiotics were non-inferior to treatment with appendectomy in the short term. This large, randomized trial compared a 10-day course of antibiotic therapy with appendectomy at 25 U.S. centers. At 90 days, 30% of participants treated with antibiotics had undergone an appendectomy.A subsequent systematic review and meta-analysis, including eight randomized clinical trials, found that both types of appendicitis cures have similar treatment success and likelihood of major complications. However, the results showed that patients treated with antibiotics alone are likely to have a longer hospital stay and a higher rate of recurrent appendicitis than appendectomy.
Efficacy of Antibiotic-Only Treatment of Appendicitis
Results from the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) reported that antibiotics were non-inferior to treatment with appendectomy in the short term. This large, randomized trial compared a 10-day course of antibiotic therapy with appendectomy at 25 U.S. centers. At 90 days, 30% of participants treated with antibiotics had undergone an appendectomy.A subsequent systematic review and meta-analysis, including eight randomized clinical trials, found that both types of appendicitis cures have similar treatment success and likelihood of major complications. However, the results showed that patients treated with antibiotics alone are likely to have a longer hospital stay and a higher rate of recurrent appendicitis than appendectomy.
Results from the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) reported that antibiotics were non-inferior to treatment with appendectomy in the short term. This large, randomized trial compared a 10-day course of antibiotic therapy with appendectomy at 25 U.S. centers. At 90 days, 30% of participants treated with antibiotics had undergone an appendectomy.
A subsequent systematic review and meta-analysis, including eight randomized clinical trials, found that both types of appendicitis cures have similar treatment success and likelihood of major complications. However, the results showed that patients treated with antibiotics alone are likely to have a longer hospital stay and a higher rate of recurrent appendicitis than appendectomy.
When acute appendicitis treatment requires surgery, medication can promote healing and prevent infection. The type of medication taken after surgery depends on the type of surgery you had and the severity of appendicitis.
An appendectomy can be performed using open surgery orlaparoscopy.General anesthesiais used during both types of procedures. The laparoscopic approach typically has a faster recovery time, less post-surgical pain, and smaller incisions than open surgery.
The following pain-reducing medications (analgesics) are some of the most common for after an appendectomy:
Opioids (may be administered via IV while you recover in the hospital or as oral pills that you take at home):
Non-steroidal anti-inflammatory drugs (NSAIDs):
After Surgery
In addition to pain medication, your post-surgical treatment may include medication for preventing the spread of infection. Depending on your condition, you may start with broad-spectrum antibiotics before your surgery.
Research has indicated that preoperative antibiotic prophylaxis is effective in decreasing wound infection and abscesses. The most common antibiotics for this are cephalosporin and imidazole derivatives. These medications—usually administered intravenously—include:
For non-perforated appendicitis, preoperative antibiotic treatment is sufficient. However, treatment with post-operative antibiotics for a period of three to five days is considered the standard of care for patients whose appendicitis involved a perforated appendix.
For people with mild-to-moderate severity or perforated or abscessed appendicitis:
For high-risk patients or those with severe physiological disturbance, advanced age, or immunocompromised state:
Are There Non-Drug Options for Appendicitis Treatment?
In addition to medications, you can promote post-surgical healing with the following non-drug options:
Like all medications, the drugs that treat appendicitis or the pain and/or infection of surgery put you at risk of having certain side effects. The impact can differ due to many factors, such as your unique physical reaction to certain drugs and interactions with other medications. These reactions can range in severity and frequency.
Common side effects of medications for appendicitis include the following symptoms:
Antibiotics
NSAIDs
Opioids
Abdominal Discomfort
When the mucosal membrane is altered or damaged, it can trigger gastritis, an inflammation of the stomach lining. The result can cause the following symptoms:
Safe Use of NSAIDs and Opioids
Is There a ‘Best’ Antibiotic for Appendicitis?
There isn’t one “best” antibiotic for appendicitis. Like all medications, the “best” medication for your condition depends on many factors, including the details of your problem and personal characteristics like your age, medical history, and other medical issues that could affect your treatment.
Researchers who examined antibiotic therapy at 25 U.S. centers reported that antibiotics were not standardized. However, the most common regimens included a combination of the following IV and oral medications:
Initial IV use of one of the following antibiotics for at least 24 hours:
Oral administration of Flagyl (metronidazole) plus Ciloxan (ciprofloxacin) or Omnicef (cefdinir) for the remainder of the treatment time, for a total of 10 days of IV and oral treatment
Summary
Appendicitis is a severe problem that needs prompt care. Without the right treatment, the damaged organ can rupture and spread germs into your stomach. The result can cause internal damage and threaten your life.
The problem can be treated with antibiotics or surgery, called an appendectomy, to remove the damaged organ. Both options use drugs to prevent the spread of disease and reduce pain. The treatment you receive and the drugs you take can vary.
Your options depend on the threat of organ rupture, the extent of organ damage, and factors like your age and other medical issues. The right treatment can solve the problem and reduce the risk of recurrence.
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Köhler F, Hendricks A, Kastner C, et al.Laparoscopic appendectomy versus antibiotic treatment for acute appendicitis—a systematic review.Int J Colorectal Dis36, 2283–2286 (2021). doi:10.1007/s00384-021-03927-5American College of Surgeons.COVID-19 guidelines for triage of emergency general surgery patients.University of Washington Medicine.Antibiotics for appendicitis: study findings finalized.Bradley AC, Hutson MS, Kyle JA.Acute appendicitis in adults.US Pharm.2019:44(12):HS-2-HS-9The CODA Collaborative.A randomized trial comparing antibiotics with appendectomy for appendicitis.N Engl J Med. 2020;383(20):1907-1919. doi:10.1056/NEJMoa2014320de Almeida Leite RM, Seo DJ, Gomez-Eslava B, et al.Nonoperative vs operative management of uncomplicated acute appendicitis: a systematic review and meta-analysis.JAMA Surgery. 2022;157(9):828-834. doi:10.1001/jamasurg.2022.2937MHA Keystone Center.Your guide to controlling & managing pain after surgery.Daskalakis K, Juhlin C, and Påhlman L.The use of pre- or postoperative antibiotics in surgery for appendicitis: a systematic review.Scandinavian Journal of Surgery.2014;103(1)14-20. doi:10.1177/1457496913497433Kaiser Permanente.Appendectomy: what to expect at home.Mohsen S, Dickinson JA, Somayaji R.Update on the adverse effects of antimicrobial therapies in community practice.Can Fam Physician.2020 Sep;66(9):651-659.American College of Rheumatology.NSAIDs (nonsteroidal anti-inflammatory drugs).National Institute on Drug Abuse.Prescription opioids DrugFacts.Philpott HL, Nandurkar S, Lubel J, Gibson PR.Drug-induced gastrointestinal disorders.Frontline Gastroenterol.2014 Jan;5(1):49-57. doi:10.1136/flgastro-2013-100316University of Rochester Medical Center.Taking NSAIDs safely.DeRoss A, Fathalizadeh A.Appendicitis management: Is it time for a change?CCJM. 2022;89(6):309-313. doi:10.3949/ccjm.89a.21012
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Köhler F, Hendricks A, Kastner C, et al.Laparoscopic appendectomy versus antibiotic treatment for acute appendicitis—a systematic review.Int J Colorectal Dis36, 2283–2286 (2021). doi:10.1007/s00384-021-03927-5American College of Surgeons.COVID-19 guidelines for triage of emergency general surgery patients.University of Washington Medicine.Antibiotics for appendicitis: study findings finalized.Bradley AC, Hutson MS, Kyle JA.Acute appendicitis in adults.US Pharm.2019:44(12):HS-2-HS-9The CODA Collaborative.A randomized trial comparing antibiotics with appendectomy for appendicitis.N Engl J Med. 2020;383(20):1907-1919. doi:10.1056/NEJMoa2014320de Almeida Leite RM, Seo DJ, Gomez-Eslava B, et al.Nonoperative vs operative management of uncomplicated acute appendicitis: a systematic review and meta-analysis.JAMA Surgery. 2022;157(9):828-834. doi:10.1001/jamasurg.2022.2937MHA Keystone Center.Your guide to controlling & managing pain after surgery.Daskalakis K, Juhlin C, and Påhlman L.The use of pre- or postoperative antibiotics in surgery for appendicitis: a systematic review.Scandinavian Journal of Surgery.2014;103(1)14-20. doi:10.1177/1457496913497433Kaiser Permanente.Appendectomy: what to expect at home.Mohsen S, Dickinson JA, Somayaji R.Update on the adverse effects of antimicrobial therapies in community practice.Can Fam Physician.2020 Sep;66(9):651-659.American College of Rheumatology.NSAIDs (nonsteroidal anti-inflammatory drugs).National Institute on Drug Abuse.Prescription opioids DrugFacts.Philpott HL, Nandurkar S, Lubel J, Gibson PR.Drug-induced gastrointestinal disorders.Frontline Gastroenterol.2014 Jan;5(1):49-57. doi:10.1136/flgastro-2013-100316University of Rochester Medical Center.Taking NSAIDs safely.DeRoss A, Fathalizadeh A.Appendicitis management: Is it time for a change?CCJM. 2022;89(6):309-313. doi:10.3949/ccjm.89a.21012
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Köhler F, Hendricks A, Kastner C, et al.Laparoscopic appendectomy versus antibiotic treatment for acute appendicitis—a systematic review.Int J Colorectal Dis36, 2283–2286 (2021). doi:10.1007/s00384-021-03927-5American College of Surgeons.COVID-19 guidelines for triage of emergency general surgery patients.University of Washington Medicine.Antibiotics for appendicitis: study findings finalized.Bradley AC, Hutson MS, Kyle JA.Acute appendicitis in adults.US Pharm.2019:44(12):HS-2-HS-9The CODA Collaborative.A randomized trial comparing antibiotics with appendectomy for appendicitis.N Engl J Med. 2020;383(20):1907-1919. doi:10.1056/NEJMoa2014320de Almeida Leite RM, Seo DJ, Gomez-Eslava B, et al.Nonoperative vs operative management of uncomplicated acute appendicitis: a systematic review and meta-analysis.JAMA Surgery. 2022;157(9):828-834. doi:10.1001/jamasurg.2022.2937MHA Keystone Center.Your guide to controlling & managing pain after surgery.Daskalakis K, Juhlin C, and Påhlman L.The use of pre- or postoperative antibiotics in surgery for appendicitis: a systematic review.Scandinavian Journal of Surgery.2014;103(1)14-20. doi:10.1177/1457496913497433Kaiser Permanente.Appendectomy: what to expect at home.Mohsen S, Dickinson JA, Somayaji R.Update on the adverse effects of antimicrobial therapies in community practice.Can Fam Physician.2020 Sep;66(9):651-659.American College of Rheumatology.NSAIDs (nonsteroidal anti-inflammatory drugs).National Institute on Drug Abuse.Prescription opioids DrugFacts.Philpott HL, Nandurkar S, Lubel J, Gibson PR.Drug-induced gastrointestinal disorders.Frontline Gastroenterol.2014 Jan;5(1):49-57. doi:10.1136/flgastro-2013-100316University of Rochester Medical Center.Taking NSAIDs safely.DeRoss A, Fathalizadeh A.Appendicitis management: Is it time for a change?CCJM. 2022;89(6):309-313. doi:10.3949/ccjm.89a.21012
Köhler F, Hendricks A, Kastner C, et al.Laparoscopic appendectomy versus antibiotic treatment for acute appendicitis—a systematic review.Int J Colorectal Dis36, 2283–2286 (2021). doi:10.1007/s00384-021-03927-5
American College of Surgeons.COVID-19 guidelines for triage of emergency general surgery patients.
University of Washington Medicine.Antibiotics for appendicitis: study findings finalized.
Bradley AC, Hutson MS, Kyle JA.Acute appendicitis in adults.US Pharm.2019:44(12):HS-2-HS-9
The CODA Collaborative.A randomized trial comparing antibiotics with appendectomy for appendicitis.N Engl J Med. 2020;383(20):1907-1919. doi:10.1056/NEJMoa2014320
de Almeida Leite RM, Seo DJ, Gomez-Eslava B, et al.Nonoperative vs operative management of uncomplicated acute appendicitis: a systematic review and meta-analysis.JAMA Surgery. 2022;157(9):828-834. doi:10.1001/jamasurg.2022.2937
MHA Keystone Center.Your guide to controlling & managing pain after surgery.
Daskalakis K, Juhlin C, and Påhlman L.The use of pre- or postoperative antibiotics in surgery for appendicitis: a systematic review.Scandinavian Journal of Surgery.2014;103(1)14-20. doi:10.1177/1457496913497433
Kaiser Permanente.Appendectomy: what to expect at home.
Mohsen S, Dickinson JA, Somayaji R.Update on the adverse effects of antimicrobial therapies in community practice.Can Fam Physician.2020 Sep;66(9):651-659.
American College of Rheumatology.NSAIDs (nonsteroidal anti-inflammatory drugs).
National Institute on Drug Abuse.Prescription opioids DrugFacts.
Philpott HL, Nandurkar S, Lubel J, Gibson PR.Drug-induced gastrointestinal disorders.Frontline Gastroenterol.2014 Jan;5(1):49-57. doi:10.1136/flgastro-2013-100316
University of Rochester Medical Center.Taking NSAIDs safely.
DeRoss A, Fathalizadeh A.Appendicitis management: Is it time for a change?CCJM. 2022;89(6):309-313. doi:10.3949/ccjm.89a.21012
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