Appendicectomy remains treatment of choice for patients with acute appendicitis

Acute appendicitis is a common condition that almost all doctors will encounter at some point during their career. Until recently patients were usually treated surgically with an appendicectomy, with antibiotics used for those with prohibitively high perioperative risks because of comorbidities or an appendiceal mass. However, conservative management of acute appendicitis was advocated during the covid-19 pandemic because of concerns about aerosol formation during laparoscopic surgery and higher risk of morbidity and mortality in patients with covid-19.12 Further evidence has accumulated on the safety and effectiveness of antibiotics in adults with acute appendicitis.345678 This, together with greater use of computed tomography to identify complications, has shifted attitudes and led to antibiotic treatment becoming more widely used.

Although antibiotic treatment can be effective in patients with uncomplicated appendicitis (box 1), some will still require surgery, which may be more extensive if antibiotics fail and surgery is delayed, and there is a substantial risk of recurrence.910111213 Patients need to be informed about treatment alternatives and made aware of all the relevant risks so that they can decide what is most suitable for their circumstances. However, we argue that antibiotics should not be presented as an equivalent treatment to surgery when explaining therapeutic options.