Medical researchers have published new findings suggesting that antibiotics are a viable alternative to surgery for adults with uncomplicated acute appendicitis. Long-term data released in early 2026 indicates that while surgery remains the standard for permanent resolution, many patients successfully avoid the operating room for years by using medication alone. This discovery offers a significant shift in how doctors and patients discuss treatment for one of the most common surgical emergencies.
The latest evidence comes from a 10-year follow-up of the Appendicitis Acuta (APPAC) trial, which tracked patients in Finland who were treated with antibiotics instead of an appendectomy. The study, published in JAMA on January 21, 2026, followed 530 adults between the ages of 18 and 60. By the end of the decade-long observation period, researchers found that more than half of the patients who initially chose antibiotics never required surgery.
Long-Term Success Rates and Recurrence
The APPAC trial results provide a clear picture of the risks and benefits associated with non-surgical treatment. Among the participants who received antibiotics, the cumulative rate of appendectomy over ten years was 44.3 percent. This means that while approximately 38 percent of patients experienced a confirmed recurrence of appendicitis, a majority of the antibiotic group successfully managed the condition without ever undergoing an operation during the decade of monitoring.
Patient satisfaction remains high for those who avoid surgery. Data shows that over 90 percent of patients who were successfully treated with antibiotics would choose that same path again. However, for those who eventually required an appendectomy after their initial antibiotic treatment failed, less than half said they would make the same choice in the future. Experts note that it remains difficult to predict which specific patients are most likely to face a recurrence.
Comparing Outcomes in Pediatric Care
While antibiotics show promise for adults, recent large-scale research involving children suggests a different outcome for younger patients. The APPY study, a major international trial involving 11 children’s hospitals, found that antibiotics are significantly less effective than surgery for children aged five to 16. In this group, the treatment failure rate for those receiving medication was 34 percent within just one year, compared to a much lower failure rate for those receiving traditional surgery.
Children treated with antibiotics also faced different challenges than adults. The pediatric study revealed that young patients receiving medication often stayed in the hospital longer than those who had surgery. Despite this, there were some short-term benefits, such as a faster return to school and normal activities for the children who did not undergo an operation. However, the higher risk of mild-to-moderate adverse events in the antibiotic group led researchers to conclude that surgery remains the more reliable option for non-perforated cases in children.
Making the Right Treatment Decision
The choice between medication and the operating table often depends on the individual’s specific medical situation and personal priorities. For adults with uncomplicated cases, antibiotics offer a way to avoid the risks of surgery, even if there is a nearly 45 percent chance the appendix will eventually need to be removed. The long-term data supports including this as a standard option during consultations, allowing patients to weigh the possibility of future recurrence against the immediate recovery of a non-invasive approach.
For parents and pediatricians, the decision involves balancing the desire to avoid surgery with the higher likelihood of treatment failure in children. While researchers continue to study whether some children could be treated with only pain management or without hospitalization, current evidence strongly favors appendectomy for consistent long-term results in the pediatric population. These ongoing studies aim to further refine which patients, regardless of age, are the best candidates for non-surgical care.
